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NPI Code Detail

MEDICARE: RON M BANNISTER OD

MEDICARE: RON M BANNISTER OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT000844GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10271120001OTHERGADME-MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
240064OTHERGAAVESIS PIN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053417956
Entity Type Code : Individual
Provider Name (Legal Business Name) : RON M BANNISTER OD
Provider Business Mailing Address
First Line : 102 S DAWSON ST
Second Line :
City : THOMASVILLE
State : GA
Zip : 31792-5185
Country : US
Telephone Number : 229-226-9190
Fax Number : 229-226-8824
Provider Business Practice Location Address
First Line : 15196 US HIGHWAY 19 S
Second Line :
City : THOMASVILLE
State : GA
Zip : 31757-4820
Country : US
Telephone Number : 229-228-4770
Fax Number : 229-225-9060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 02/15/2018

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Directions to “ RON M BANNISTER OD” Practice Location

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