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Individual

DR. MICHAEL JOSEPH BANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1500 S CHURCH ST, WATERTOWN, WI 53094-6404
(920) 261-9225
Mailing address
700 POPLAR PATH, DELAFIELD, WI 53018-1828
(262) 490-7697

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3625-35
WI

Other

Enumeration date
07/01/2020
Last updated
07/01/2020
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