Dr Bennett LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DR BENNETT LLC

Practice address

1850 E Dupont Rd
Fort Wayne, IN 46825-1581

Phone

(260) 490-1060

NPI assigned

Jun 8, 2020

Organization subpart

Yes

Parent organization

DR BENNETT LLCAs reported in NPPES

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

Authorized official

Name

Dr. Lance Bennett, OD

Title

Optometrist

Phone

(260) 417-3467

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Dr Bennett LLC

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1164046967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251581",
            "telephone_number": "260-490-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251581",
            "telephone_number": "260-490-1060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 N 13th St",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IN",
            "postal_code": "467333139",
            "country_code": "US",
            "telephone_number": "260-724-2517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DR BENNETT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DR BENNETT LLC",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "260-417-3467",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13641379",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.