Provider Demographics
NPI:1558567354
Name:BENNION, KENT JAY (OD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:JAY
Last Name:BENNION
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 N MOAPA VALLEY BLVD, SUITE D
Mailing Address - Street 2:BOX 1349
Mailing Address - City:OVERTON
Mailing Address - State:NV
Mailing Address - Zip Code:89040-1349
Mailing Address - Country:US
Mailing Address - Phone:702-397-2020
Mailing Address - Fax:702-397-6422
Practice Address - Street 1:1170 N MOAPA VALLEY BLVD, STE D
Practice Address - Street 2:PO BOX 1349
Practice Address - City:OVERTON
Practice Address - State:NV
Practice Address - Zip Code:89040-1349
Practice Address - Country:US
Practice Address - Phone:702-397-2020
Practice Address - Fax:702-397-6422
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6640313-9934152W00000X
NV935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist