Kristie J Bennett, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002410 Issued in GA

Practice address

1056 N Highland Ave NE
Atlanta, GA 30306-3551

Phone

(404) 343-0887

Fax

(404) 343-2024

NPI assigned

May 10, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kristie J Kudlac Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

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.

• Highland Eye Boutique, LLC

  • Optometrist
  • Atlanta, GA
  • NPI 1285959346

  GA, Optometrist

  Medicare reassignment NPD Authorized official
• Atlanta Ophthalmology Associates PC

  • Specialist
  • Atlanta, GA
  • NPI 1548384738
  NPD (past)
• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  NPD (past)
• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573
  NPD (past)

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462320000000",
    "number": "1427008705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1056 N HIGHLAND AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303063551",
            "telephone_number": "404-343-0887",
            "fax_number": "404-343-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1056 N HIGHLAND AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303063551",
            "telephone_number": "404-343-0887",
            "fax_number": "404-343-2024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "KRISTIE",
        "middle_name": "J",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2016-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4510",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIE",
            "last_name": "KUDLAC",
            "middle_name": "J",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gertrude Kristine Bennett, M.D.
• James K Bennett, M.D.
• Janai Bennett
• Josiah Bennett, MD
• Kaleigh Coon Bennett, CAA
• Leigh Donna Bennett, LPC, NCC
• Lisa E. Bennett, MD
• Mackenzie Price Bennett, MD
• Mark Sean Bennett, CRNA
• Matthew Ryan Bennett, RN

• All providers in Atlanta, GA
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.