Dr Bennett LLC
Optometrist in Fort Wayne, IN. Organization (NPI-2).
NPI number1164046967
StatusActive
Last updated in NPPESJun 17, 2020
Details
- NPI
- 1164046967
- Entity type
- Organization (NPI-2)
- Legal business name
- Dr Bennett LLC
- Organization subpart
- Yes
- Enumeration date
- Jun 8, 2020
- Certification date
- Jun 17, 2020
- Last updated
- Jun 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | – | – | Yes |
Practice location
1850 E Dupont RdFort Wayne, IN 46825-1581
Phone 260-490-1060
Mailing address
1850 E Dupont RdFort Wayne, IN 46825-1581
Phone 260-490-1060
Other practice locations
1401 N 13th St
Decatur, IN 46733-3139
Decatur, IN 46733-3139
Phone 260-724-2517
Authorized official
Lance Bennett
Optometrist
2604173467
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