Provider Demographics
NPI:1669455747
Name:BENNETT, DAVID SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:BENNETT
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 1:2441 NW PRAIRIE VIEW RD STE A
Mailing Address - Street 2:
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 TRFY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5165
Practice Address - Country:US
Practice Address - Phone:816-453-5814
Practice Address - Fax:816-453-2859
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312478241Medicaid
MO312478241Medicaid
L801994Medicare PIN