Provider Demographics
NPI:1659640969
Name:BENNETT FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:BENNETT FAMILY EYE CARE PC
Other - Org Name:LINDA BENNETT, O.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:MAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-484-1414
Mailing Address - Street 1:231 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3607
Mailing Address - Country:US
Mailing Address - Phone:617-484-1414
Mailing Address - Fax:617-489-1957
Practice Address - Street 1:231 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3607
Practice Address - Country:US
Practice Address - Phone:617-484-1414
Practice Address - Fax:617-489-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2870152W00000X
MA4405152W00000X
MA4679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty