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RON M BANNISTER OD

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1053417956

Individual Registrant:
 RON M BANNISTER OD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
15196 US HIGHWAY 19 S  THOMASVILLE, GA 31757-4820 US
Tel: 229-228-4770  Fax: 229-225-9060

Contact information for business:
102 S DAWSON ST  THOMASVILLE, GA 31792-5185 US
Tel: 229-226-9190  Fax: 229-226-8824

Registration Information:
NPI: 1053417956
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
GAOPT000844

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
AVESIS PIN40064GA01
000139334AGA05
DME-MEDICARE0271120001GA01




HEALTH CARE JOBS GA - Page 1



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