NPIMap

Organization Active NPI

Bennett Optometry LLC

Doing business as Clarkson Eyecare

  • Optometrist
  • East Lansing, MI
National Provider Identifier
1265022552
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BENNETT OPTOMETRY LLC
Doing business as
Clarkson Eyecare
Practice address
330 W Lake Lansing Rd
East Lansing, MI 48823-8527
Phone
(636) 200-4393
Fax
(636) 527-0766
NPI assigned
Jan 21, 2021
Last updated
Mar 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Authorized official

Name
James WachterNPI 1689670697
Title
Cmo
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

330 W Lake Lansing Rd
East Lansing, MI 48823-8527

Mailing address

PO Box 208177
Dallas, TX 75320-8177
Phone (636) 200-4393

Other names 1

  • Clarkson Eyecare 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

Practitioners & affiliated clinicians

Practitioners 1

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": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1265022552",
    "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": "330 W LAKE LANSING RD",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488238527",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "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"
    },
    "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"
        },
        {
            "organization_name": "Clarkson Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.