Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5787 | OH |
NPI | 1003063504 |
---|---|
Provider Name | Dr. Melissa Marie Bennett |
First Address | Grove City, OH 43123-8271 |
Second Address | Chillicothe, OH 45601-9718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2008 |
Last Update Date | 12/07/2013 |