Active NPI
Eugene D. Bennett
- Optometrist
- Tyler, TX
National Provider Identifier
1922273754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1848
- Legal business name
- EUGENE D. BENNETT
- Practice address
- 4824 S Broadway Ave
Tyler, TX 75703-1312 - Phone
- (903) 581-2020
- Fax
- (903) 509-1492
- NPI assigned
- Apr 23, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Eugene D Bennett, OD
- Title
- Owner
- Phone
- (903) 581-2020
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1848 | TX | Primary |
Addresses
Primary practice location
4824 S Broadway Ave
Tyler, TX 75703-1312
Mailing address
4824 S Broadway Ave
Tyler, TX 75703-1312
Phone (903) 581-2020
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019677601 | Medicaid | TX | |
| 82046E | Other | TX | MEDICARE |
| 00E60M | Other | TX | MEDICARE |
| 1679627301 | Other | TX | NPI |
National Provider Directory
National Provider DirectoryLocations
4824 S Broadway Ave
Tyler, TX 75703
Phone (903) 581-2020
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Tyler, TX
- NPI 1679627301
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208908800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1263254400000",
"number": "1922273754",
"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": {
"organization_name": "EUGENE D. BENNETT",
"organizational_subpart": "NO",
"enumeration_date": "2008-04-23",
"last_updated": "2010-01-12",
"status": "A",
"authorized_official_last_name": "BENNETT",
"authorized_official_first_name": "EUGENE",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "903-581-2020",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY 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": "MEDICARE",
"identifier": "82046E",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "00E60M",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1679627301",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.