Individual provider Active NPI

Lance Bennett, OD

  • Optometrist
  • Angola, IN
National Provider Identifier
1962871806
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18004017A Issued in IN
Practice address
1400 N Wayne St Ste D
Angola, IN 46703-2359
Phone
(260) 668-8881
Fax
(260) 665-6498
NPI assigned
Sep 22, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18004017A IN Primary

Addresses

Primary practice location

1400 N Wayne St Ste D
Angola, IN 46703-2359

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Elkhart Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230719003532 IN Practitioner - Optometry 1557721743 Reassigns benefits to 1 organization
I20230818003449 MI Practitioner - Optometry 1557721743 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Indiana LLC 82 clinicians

Practice addresses (Care Compare)

1400 N Wayne St
Suite D
Angola, IN 46703-2359
Phone (260) 668-8881

208 W N St
Kendallville, IN 46755-1134
Phone (260) 349-1008

9760 Lantern Rd
Fishers, IN 46037-9612
Phone (317) 577-9200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18004017AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Jul 1, 2023 Accepting new patients
Myeyedr Optometry of Michigan, LLC Optometrist CurrentSince Jul 17, 2023 Accepting new patients
Myeyedr Optometry of Michigan, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Jul 1, 2023 Accepting new patients
Myeyedr Optometry of Michigan, LLC Optometrist CurrentSince Jul 17, 2023 Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist Current Accepting new patients
RX Optical Laboratories, Inc. Optometrist PastSince Jul 16, 2023 Accepting new patients

Locations

1400 N Wayne St
Ste F
Angola, IN 46703
Phone (260) 668-8881

1400 N Wayne St
Ste D
Angola, IN 46703
Phone (260) 668-8881

9760 Lantern Rd
Fishers, IN 46037
Phone (317) 577-9200

208 W North St
Kendallville, IN 46755
Phone (260) 349-1008

65 Columbia Ave E
Battle Creek, MI 49015
Phone (269) 342-0003

755 E Chicago St
Coldwater, MI 49036
Phone (517) 278-9004

800 S Brown St
Jackson, MI 49203
Phone (517) 787-8890

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1962871806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N WAYNE ST STE D",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467032359",
            "telephone_number": "260-668-8881",
            "fax_number": "260-665-6498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "LANCE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-22",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004017A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Elkhart",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Elkhart",
            "address_1": "904 Parkway Ave",
            "city": "Elkhart",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465169337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Angola, IN

Sources for this page

Verify at the official NPI Registry.