Active NPI
Steven I Bennett, O.D.
- Optometrist
- Ann Arbor, MI
National Provider Identifier
1316930670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002604
- Practice address
- 117 S Main St
Ann Arbor, MI 48104-1902 - Phone
- (734) 665-5306
- Fax
- (734) 930-2383
- NPI assigned
- Aug 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002604 | MI | Primary |
| Corneal and Contact Management Optometrist | 152WC0802X | 4901002604 | MI | |
| Low Vision Rehabilitation Optometrist | 152WL0500X | 4901002604 | MI | |
| Pediatric Optometrist | 152WP0200X | 4901002604 | MI | |
| Occupational Vision Optometrist | 152WX0102X | 4901002604 | MI |
Addresses
Primary practice location
117 S Main St
Ann Arbor, MI 48104-1902
Mailing address
117 S Main St
Ann Arbor, MI 48104-1902
Phone (734) 665-5306
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2675077 | Medicaid | MI | |
| SB002604 | Other | MI | BCBS MICHIGAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002604 | MI | MD | Pediatric Optometrist |
Interoperability endpoints
- stevenbennett@direct.eyecare-partners.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360281600000",
"number": "1316930670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 S MAIN ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481041902",
"telephone_number": "734-665-5306",
"fax_number": "734-930-2383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 S MAIN ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481041902",
"telephone_number": "734-665-5306",
"fax_number": "734-930-2383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "STEVEN",
"middle_name": "I",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2013-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002604",
"primary": true
},
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "MI",
"license": "4901002604",
"primary": false
},
{
"code": "152WL0500X",
"taxonomy_group": "",
"desc": "Optometrist, Low Vision Rehabilitation",
"state": "MI",
"license": "4901002604",
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "MI",
"license": "4901002604",
"primary": false
},
{
"code": "152WX0102X",
"taxonomy_group": "",
"desc": "Optometrist, Occupational Vision",
"state": "MI",
"license": "4901002604",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2675077",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MICHIGAN",
"identifier": "SB002604",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}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 Feb 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.