Provider Demographics
NPI:1346492865
Name:BENNETT EYECARE MIDWEST, LLC
Entity Type:Organization
Organization Name:BENNETT EYECARE MIDWEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDNAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-454-2020
Mailing Address - Street 1:2441 NW PRAIRIE VIEW RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7608
Mailing Address - Country:US
Mailing Address - Phone:816-858-2522
Mailing Address - Fax:816-858-2946
Practice Address - Street 1:6080 N OAK TRWY
Practice Address - Street 2:SUITE 101
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5100
Practice Address - Country:US
Practice Address - Phone:816-454-2020
Practice Address - Fax:816-453-2659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENNETT EYECARE MIDWEST, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-15
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505840207Medicaid
MO4508490001Medicare NSC