Basic Information
| Provider Information | |||||||||
| NPI: | 1245856970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 BREMO RD STE 128A | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779690392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7347 BELL CREEK RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231113504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047465245 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2020 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618002896 | VA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.