Organization
DR BENNETT LLC
Active
Parent organization
DR BENNETT LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DR BENNETT LLC
Authorized official
DR. LANCE BENNETT OD (OPTOMETRIST)
(260) 417-3467
Entity
Organization
Contact information
Practice address
1850 E DUPONT RD, FORT WAYNE, IN 46825-1581
(260) 490-1060
Mailing address
1850 E DUPONT RD, FORT WAYNE, IN 46825-1581
(260) 490-1060
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13641379
CAQH
—
Enumeration date
06/08/2020
Last updated
06/17/2020
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