ELIJAH ALLAN JACKSON BANNISTER

LONGVIEW, WA
NPI1558093591
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy152W00000X Optometrist
(Licence: WA  OD61311755)
Enumeration Date2022-06-28
Last Update Date2022-08-02
Business Address
ELIJAH ALLAN JACKSON BANNISTER OD
820 OCEAN BEACH HWY STE 100
LONGVIEW, WA 98632-4081
Phone number: 360-636-2020
Mailing Address
ELIJAH ALLAN JACKSON BANNISTER OD
PO BOX 1939
KALAMA, WA 98625-1700
Phone number: 360-560-5322