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RON M BANNISTER OD
>> Optometrist >> Eye and Vision Services ProvidersRegistrant NPI Number: 1053417956
Individual Registrant: RON M BANNISTER OD
Gender: M
Not Sole Proprietor
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
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
Tel: 229-226-9190 Fax: 229-226-8824
Registration Information:
NPI: 1053417956
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 152W00000X | Eye and Vision Services Providers Optometrist | GA | OPT000844 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| AVESIS PIN | 40064 | GA | 01 |
| 000139334A | GA | 05 | |
| DME-MEDICARE | 0271120001 | GA | 01 |
