1134372873 NPI number — BENNETT EYECARE MIDWEST, LLC

Table of content: (NPI 1134372873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134372873 NPI number — BENNETT EYECARE MIDWEST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENNETT EYECARE MIDWEST, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134372873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2441 NW PRAIRIE VIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLATTE CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64079-7627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-858-2522
Provider Business Mailing Address Fax Number:
816-858-2946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1504 N CHURCH RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-7163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-781-3442
Provider Business Practice Location Address Fax Number:
816-415-9743
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RONDEAU
Authorized Official First Name:
ABBIE
Authorized Official Middle Name:
NELL
Authorized Official Title or Position:
CREDENTIALING OFFICER
Authorized Official Telephone Number:
816-858-2522

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 535840201 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505840207 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1528041860 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1811159361 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1669455747 . This is a "NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 318693827 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407839756 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 312478241 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 316013606 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com