Michael Joseph Bannon, OD Valid NPI
Individual provider · Optometrist · Watertown, WI
- NPI
- 1124645585
- Type
- Individual (Type 1)
- Primary specialty
- Optometrist
- Specialty group
- Eye and Vision Services Providers
- Taxonomy code
- 152W00000X
- License number
- 3625-35 (WI)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2020-07-01
- Last updated
- 2020-07-01
Practice location
1500 S Church St
Watertown, WI 53094-6404
(920) 261-9225