NPIMap

Organization Active NPI

Bennett Optometry LLC

  • Optometrist
  • Lansing, MI
National Provider Identifier
1609449123
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BENNETT OPTOMETRY LLC
Practice address
5403 W Saginaw Hwy
Lansing, MI 48917-1918
Phone
(517) 886-0222
Fax
(517) 886-0224
NPI assigned
Jul 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
James Wachter
Title
Cmo
Phone
(636) 200-4393

Specialties & licenses 1

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

Addresses

Primary practice location

5403 W Saginaw Hwy
Lansing, MI 48917-1918

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
Tax ID family
Bennett Optometry LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the 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.

NPI Registry JSON

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1609449123",
    "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": "5403 W SAGINAW HWY",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489171918",
            "telephone_number": "517-886-0222",
            "fax_number": "517-886-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "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"
        }
    ]
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.