McKenzie Jolie Ann Bennett, LDO

Primary specialty

OpticianTaxonomy code 156FX1800X

License

60389139 Issued in WA

Practice address

700 Sleater Kinney Rd SE Ste E
Lacey, WA 98503-1113

Phone

(253) 209-4295

NPI assigned

Feb 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Optical Cross LLC

  dba Capital Eyes Optical

  • Eyewear Supplier
  • Lacey, WA
  • NPI 1093438327
  NPD Authorized official

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1225782428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SLEATER KINNEY RD SE STE E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031113",
            "telephone_number": "253-209-4295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SLEATER KINNEY RD SE STE E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031113",
            "telephone_number": "253-209-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MCKENZIE",
        "middle_name": "JOLIE ANN",
        "name_prefix": "Ms.",
        "credential": "LDO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-07",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "WA",
            "license": "60389139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DISPENSING OPTICIANS LICENSE",
            "identifier": "DO60389139",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Belton
• Danilynn Benavente
• John David Benford
• Amber Bennett
• Lynne Marie Bennett, ARRT RM
• Sadie Karean Bennett
• Shannon Elise Bennett, LMT, CD(DONA)
• Sandy Jean Benning Nussbaum
• Sheila Benning
• Joyce Benoit-Dastous, RN

• Optician in Lacey, WA
• Providers in Lacey, WA by specialty
• Optician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.