NPIMap

Organization Active NPI

Bennett Optometry LLC

Doing business as Bennett Optometry

  • Optometrist
  • Ann Arbor, MI
National Provider Identifier
1992792154
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
BME-0160973 Issued in MI
Legal business name
BENNETT OPTOMETRY LLC
Doing business as
Bennett Optometry
Practice address
117 S Main St
Ann Arbor, MI 48104-1902
Phone
(636) 200-4393
Fax
(734) 665-5522
NPI assigned
Oct 3, 2005
Last updated
Sep 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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

Authorized official

Name
James J. Wachter, O.D.NPI 1689670697
Title
President/Owner
Phone
(636) 200-4393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X BME-0160973 MI Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X
Low Vision Rehabilitation OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WL0500X
Pediatric OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WP0200X
Sports Vision OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WS0006X
Vision Therapy OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WV0400X
Occupational Vision OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WX0102X

Addresses

Primary practice location

117 S Main St
Ann Arbor, MI 48104-1902

Mailing address

117 S. Main St.
Ann Arbor, MI 48104
Phone (734) 665-5306

Other names 1

  • Bennett Optometry 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
Practice locations: East Lansing, MI; Three Rivers, MI; Tecumseh, MI; Saline, MI; Perry, MI; Okemos, MI; Novi, MI; Lansing, MI…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568332800000",
    "number": "1992792154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 S. MAIN ST.",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48104",
            "telephone_number": "734-665-5306",
            "fax_number": "734-930-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 S MAIN ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481041902",
            "telephone_number": "636-200-4393",
            "fax_number": "734-665-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2019-09-13",
        "status": "A",
        "authorized_official_last_name": "WACHTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "636-200-4393",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "BME-0160973",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bennett Optometry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bennett Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2019; 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.