Active NPI
Bennett Optometry LLC
- Optometrist
- Ann Arbor, MI
National Provider Identifier
1003427352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- BENNETT OPTOMETRY LLC
- Practice address
- 1928 W Stadium Blvd
Ann Arbor, MI 48103-4504 - Phone
- (734) 994-9119
- NPI assigned
- Aug 11, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- James Wachter, OD
- Title
- Cmo
- Phone
- (636) 200-4393
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | Primary |
Addresses
Primary practice location
1928 W Stadium Blvd
Ann Arbor, MI 48103-4504
Mailing address
PO Box 208177
Dallas, TX 75320-8177
Phone (636) 200-4393
Other names 1
- Clarkson Eyecare
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040419000779 | MI | Part B Supplier - Clinic/Group Practice | 5193719367 |
Receives reassigned benefits from 24 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: East Lansing, MI; Three Rivers, MI; Tecumseh, MI; Saline, MI; Perry, MI; Okemos, MI; Novi, MI; Lansing, MI… |
Other NPIs on the same Medicare enrollment 19
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
1928 W Stadium Blvd
Ann Arbor, MI 48103
Phone (734) 994-9119
Interoperability endpoints
- https://app.meldrx.com/api/fhir/ecp_cecmi
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597104000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1597104000000",
"number": "1003427352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 208177",
"city": "DALLAS",
"state": "TX",
"postal_code": "753208177",
"telephone_number": "636-200-4393",
"fax_number": "636-527-0766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1928 W STADIUM BLVD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481034504",
"telephone_number": "734-994-9119"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BENNETT OPTOMETRY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-08-11",
"last_updated": "2020-08-11",
"certification_date": "2020-08-11",
"status": "A",
"authorized_official_last_name": "WACHTER",
"authorized_official_first_name": "JAMES",
"authorized_official_title_or_position": "CMO",
"authorized_official_telephone_number": "636-200-4393",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Clarkson Eyecare",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.