DHP Retail Entity, LLC

Key facts

NPI

1285199562

Entity type

Organization (NPI type 2)

Primary specialty

Optometrist 152W00000X

Legal business name

DHP RETAIL ENTITY, LLC

Practice address

1680 Campbell LN Ste 104
Bowling Green, KY 42104-1062

Phone

(561) 275-2020

NPI assigned

Jan 31, 2019

Organization subpart

No

Authorized official

Name

Jackie Bennett

Title

Credentialing Manager

Phone

(561) 433-6009

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

• DHP Retail Entity, LLC Optometrist · Bowling Green, KY · NPI 1427513662
  NPD tax ID

National Provider Directory

Tax ID family

DHP Retail Entity LLC (2 organizations share this tax ID)

Specialties & licenses

Addresses

Other names

• My Eye Lab Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 31, 2019.

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1285199562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 PREAKNESS WAY",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421048563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 CAMPBELL LN STE 104",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041062",
            "telephone_number": "561-275-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DHP RETAIL ENTITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "561-433-6009"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Eye Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, KY

• Susan Diane Devine, T.V.I.
• Megan Lynn Devore, M.S., CCC-SLP
• Paula Devore, APRN
• Kevin D Dew, M.D.
• Andrea N Dexter, MPT
• DHP Retail Entity, LLC
• Retina A Dick, LPCC
• Natalie Dickerson, DPT
• Sidney Marie Dickhaus, MSW, CSW
• Amy W Dickinson, CRNA

All providers in Bowling Green, KY · Optometrist in Kentucky