Individual
JOSEPH M. BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1021 NATIONAL RD, WHEELING, WV 26003-5779
(304) 234-4455
(304) 234-4452
Mailing address
211 GREENTREE DR, SAINT CLAIRSVILLE, OH 43950-1443
(740) 695-0526
(740) 695-5209
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
3766
OH
152W00000X
Optometrist
Primary
797-OD
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410045918
MEDICARE RAILROAD
OH
Enumeration date
06/01/2005
Last updated
08/19/2008
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