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General NPI Number Information
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NPI Number | 1861571002
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Entity Type | Organization
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Legal Business Name | JOSEPH M. BANNON OD INC.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 1021 NATIONAL RD
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City | WHEELING
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State | WV
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Zip | 26003-5779
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Country | US
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Telephone | 304-234-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 NATIONAL RD
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City | WHEELING
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State | WV
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Zip | 26003-5779
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Country | US
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Telephone | 304-234-4455
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH M. BANNON
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Credential | O.D.
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Telephone | 304-234-4455
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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 | 3766
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 797D
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License Number State | WV
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