Organization
EUGENE D. BENNETT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE D BENNETT OD (OWNER)
(903) 581-2020
Entity
Organization
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
01
—
00E60M
MEDICARE
TX
05
—
019677601
—
TX
01
—
1679627301
NPI
TX
01
—
82046E
MEDICARE
TX
Enumeration date
04/23/2008
Last updated
01/12/2010
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