Eugene Bennett, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1848 Issued in TX

Practice address

4824 S Broadway Ave
Tyler, TX 75703-1312

Phone

(903) 581-2020

Fax

(903) 509-1492

NPI assigned

Jan 22, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Charles P McGonagill

  • Optometrist
  • Mineola, TX
  • NPI 1063419778
  Medicare reassignment

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eugene D. Bennett

  • Optometrist
  • Tyler, TX
  • NPI 1922273754
  NPD (past) Authorized official

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1679627301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031312",
            "telephone_number": "903-581-2020",
            "fax_number": "903-509-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4824 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031312",
            "telephone_number": "903-581-2020",
            "fax_number": "903-509-1492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "1848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019677601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "751573775",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joe B Belue, MD
• Todd David Bengtson, MD
• Benjamin Daniel Boynton PHD PLLC
• Alice Bennefield
• Daniel C Bennett, MD
• Kaitlin Bennett
• Katelynn N Bennett
• Stephanie Erin Bennett, APRN, FNP-C
• Steven Bennett, CSFA
• Nicholas C Bennie, LPC

• Optometrist in Tyler, TX
• Providers in Tyler, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.