Individual
ELYSE BANISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
8900 SE 165TH MULBERRY LN, THE VILLAGES, FL 32162-5884
(352) 674-5000
Mailing address
8900 SE 165TH MULBERRY LN, THE VILLAGES, FL 32162-5884
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG003056
PA
152W00000X
Optometrist
OPT003042
GA
Other
Enumeration date
06/26/2015
Last updated
08/25/2022
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