Individual
DR. EUGENE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4824 S BROADWAY AVE, TYLER, TX 75703-1312
(903) 581-2020
(903) 509-1492
Mailing address
4824 S BROADWAY AVE, TYLER, TX 75703-1312
(903) 581-2020
(903) 509-1492
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1848
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019677601
—
TX
01
—
751573775
TAX ID
TX
Enumeration date
01/22/2007
Last updated
07/09/2007
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