Bannon, Mark Joseph
Bannon, Mark Joseph is an sole proprietor health care provider with primary practice located at 359 Main St , Kensington CT 06037-2651. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Suppliers / Eyewear Supplier (Equipment, not the service). Suppliers / Eyewear Supplier (Equipment, not the service) is his primary health care specialty. Bannon, Mark Joseph can be contacted via phone (860) 829-1020.Contact Information
Primary practice address
359 Main St
Kensington CT 06037-2651
Phone: (860) 829-1020
Fax: (860) 828-5246
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 888 | Connecticut |
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X | 888 | Connecticut |
Profile Details
| NPI number | 1558417949 |
|---|---|
| LBN Legal business name | Bannon, Mark Joseph |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 26th, 2007 |
| Last updated | Nov 3rd, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558417949 | NPPES |
| Connecticut | MEDICAID | 004101549 |
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