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Organization

RON M BANNISTER OD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RON M BANNISTER O.D. (OWNER)
(229) 226-9190
Entity
Organization

Contact information

Practice address
102 S DAWSON ST, THOMASVILLE, GA 31792-5185
(229) 226-9190
(229) 226-8824
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
01
40064
AVESIS PIN
GA
Enumeration date
02/04/2008
Last updated
02/04/2008
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