Provider Demographics
NPI:1437208287
Name:BANNETT EYE CENTERS, PA
Entity Type:Organization
Organization Name:BANNETT EYE CENTERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BANNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-853-5554
Mailing Address - Street 1:620 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1795
Mailing Address - Country:US
Mailing Address - Phone:856-853-5554
Mailing Address - Fax:856-853-5650
Practice Address - Street 1:620 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1795
Practice Address - Country:US
Practice Address - Phone:856-853-5554
Practice Address - Fax:856-853-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04846500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025743Medicare UPIN