Individual
RON M BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
15196 US HIGHWAY 19 S, THOMASVILLE, GA 31757-4820
(229) 228-4770
(229) 225-9060
Mailing address
102 S DAWSON ST, THOMASVILLE, GA 31792-5185
(229) 226-9190
(229) 226-8824
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT000844
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000139334A
—
GA
01
—
0271120001
DME-MEDICARE
GA
01
—
40064
AVESIS PIN
GA
Enumeration date
09/16/2006
Last updated
02/15/2018
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