NPIMap

Organization Active NPI

Bennett Optometry LLC

Doing business as Bennett Optometry

  • Optometrist
  • Ann Arbor, MI
National Provider Identifier
1013904028
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
BME-0160973 Issued in MI
Legal business name
BENNETT OPTOMETRY LLC
Doing business as
Bennett Optometry
Practice address
2623 Plymouth Rd
Ann Arbor, MI 48105-2468
Phone
(636) 200-4393
Fax
(734) 930-2390
NPI assigned
Oct 4, 2005
Last updated
May 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James J. Wachter, O.D.NPI 1689670697
Title
President/Owner
Phone
(636) 200-4393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Optometrist 152W00000X BME-0160973 MI Primary
Corneal and Contact Management Optometrist 152WC0802X NU
Low Vision Rehabilitation Optometrist 152WL0500X NU
Pediatric Optometrist 152WP0200X NU
Sports Vision Optometrist 152WS0006X NU
Vision Therapy Optometrist 152WV0400X NU
Occupational Vision Optometrist 152WX0102X NU

Addresses

Primary practice location

2623 Plymouth Rd
Ann Arbor, MI 48105-2468

Mailing address

117 S Main St Ste 200
Ann Arbor, MI 48104-1902
Phone (734) 930-2373

Other names 1

  • Bennett Optometry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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.

View all 19

National Provider Directory

National Provider Directory

Locations

117 S Main St
Ste 200
Ann Arbor, MI 48104

2000 Green Rd
Ste 200
Ann Arbor, MI 48105

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1013904028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 S MAIN ST STE 200",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481041902",
            "telephone_number": "734-930-2373",
            "fax_number": "734-930-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2623 PLYMOUTH RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481052468",
            "telephone_number": "636-200-4393",
            "fax_number": "734-930-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "WACHTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "636-200-4393",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "BME-0160973",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "",
            "desc": "Optometrist, Occupational Vision",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bennett Optometry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bennett Optometry",
            "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 May 15, 2024; 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.

Verify at the official NPI Registry.