MEDICARE: BENNETT EYE CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1316580160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENNETT EYE CARE PLLC

Provider Business Mailing Address
First Line	:	4575 S MERIDIAN RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-9586
Country	:	US
Telephone Number	:	989-621-1402
Fax Number	:	989-773-9406

Provider Business Practice Location Address
First Line	:	4850 ENCORE BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-6013
Country	:	US
Telephone Number	:	989-621-1402
Fax Number	:	989-773-9406

Authorized Official
Title or Position	:	OWNER
Name	:	JASON D BENNETT
Credential	:	OD
Telephone Number	:	989-772-1704

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/25/2019

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