Individual
DR. MARK JOSEPH BANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
359 MAIN ST, KENSINGTON, CT 06037-2651
(860) 829-1020
(860) 828-5246
Mailing address
359 MAIN ST, KENSINGTON, CT 06037-2651
(860) 829-1020
(860) 828-5246
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
888
CT
332H00000X
Eyewear Supplier
Primary
888
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004101549
—
CT
Enumeration date
01/26/2007
Last updated
11/03/2008
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