Provider Demographics
NPI:1225619786
Name:RAYMOND A BANNAN, MD LLC
Entity Type:Organization
Organization Name:RAYMOND A BANNAN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-676-1121
Mailing Address - Street 1:3372 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1523
Mailing Address - Country:US
Mailing Address - Phone:740-676-1121
Mailing Address - Fax:
Practice Address - Street 1:3372 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1523
Practice Address - Country:US
Practice Address - Phone:740-676-1121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty