Cheryl L Bennett OD PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

984-IOD Issued in WV

Legal business name

CHERYL L BENNETT OD PLLC

Practice address

28 Virginia Ave
Petersburg, WV 26847-1740

Phone

(304) 642-4490

NPI assigned

Jan 21, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Cheryl L Bennett, ODNPI 1245303213

Title

Doctor/Owner

Phone

(681) 892-0393

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Spectacle Family Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Tax ID family

Cheryl L Bennett OD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Cheryl L. Bennett OD, PLLC

  • Optometrist
  • Buckhannon, WV
  • NPI 1295269074
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cheryl L Bennett, OD

  • Optometrist
  • Petersburg, WV
  • NPI 1245303213
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1484956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1720525322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 VIRGINIA AVE",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471740",
            "telephone_number": "681-892-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 VIRGINIA AVE",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471740",
            "telephone_number": "304-642-4490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Buckhannon",
            "address_purpose": "LOCATION",
            "city": "Buckhannon",
            "state": "WV",
            "postal_code": "262018422",
            "country_code": "US",
            "telephone_number": "304-472-7703",
            "fax_number": "304-472-8808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHERYL L BENNETT OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-21",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "681-892-0393",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WV",
            "license": "984-IOD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3102000000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Spectacle Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Spectacle Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angel Castell
• Cameron Casto
• Maddison Champ
• Jacob Chapman
• Patricia Chapman
• Janice M Clark
• Chelsea Combs
• Megan Renee Combs
• Paula J Combs
• Commission on Aging Family Services

• Optometrist in Petersburg, WV
• Providers in Petersburg, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.