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General NPI Number Information
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NPI Number | 1679693741
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Entity Type | Individual
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Provider Name | ELISA BANO OD
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5001 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2619
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Country | US
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Telephone | 215-288-5000
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Fax | 215-744-1233
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Provider Business Mailing Address
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Address Line | 5001 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-2619
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Country | US
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Telephone | 215-288-5000
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Fax | 215-744-1233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002681
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 5793
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00851100
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License Number State | NJ
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