Elijah Allan Jackson Bannister, OD
Optometrist in Longview, WA. Individual provider (NPI-1).
NPI number1558093591
StatusActive
Last updated in NPPESAug 2, 2022
Details
- NPI
- 1558093591
- Entity type
- Individual (NPI-1)
- Name
- Elijah Allan Jackson Bannister
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 28, 2022
- Certification date
- Aug 2, 2022
- Last updated
- Aug 2, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | OD61311755 | WA | Yes |
Practice location
820 Ocean Beach Hwy Ste 100Longview, WA 98632-4081
Phone 360-636-2020
Mailing address
Po Box 1939Kalama, WA 98625-1700
Phone 360-560-5322
Other practice locations
500 Columbia St Ste A
Woodland, WA 98674-8491
Woodland, WA 98674-8491
Phone 360-225-1010
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All 22 Optometrist providers in Longview · All 2,229 providers in Longview
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