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General NPI Number Information
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NPI Number | 1437208287
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Entity Type | Organization
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Legal Business Name | BANNETT EYE CENTERS, PA
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 620 N BROAD ST
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City | WOODBURY
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State | NJ
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Zip | 08096-1795
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Country | US
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Telephone | 856-853-5554
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Fax | 856-853-5650
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Provider Business Mailing Address
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Address Line | 620 N BROAD ST
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City | WOODBURY
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State | NJ
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Zip | 08096-1795
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Country | US
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Telephone | 856-853-5554
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Fax | 856-853-5650
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGG ALLEN BANNETT
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Credential | DO
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Telephone | 856-853-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MB04846500
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License Number State | NJ
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