Provider Demographics
NPI:1043207343
Name:BENNETT, JAMES (O D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 RACQUET WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-5407
Mailing Address - Country:US
Mailing Address - Phone:970-257-3406
Mailing Address - Fax:
Practice Address - Street 1:2504 HIGHWAY 6 AND 50
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-7170
Practice Address - Country:US
Practice Address - Phone:970-257-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-02
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4077 T1986152W00000X
CO2456152W00000X
VI51152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist