Elijah Allan Jackson Bannister, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD61311755 Issued in WA

Practice address

820 Ocean Beach Hwy Ste 100
Longview, WA 98632-4081

Phone

(360) 636-2020

NPI assigned

Jun 28, 2022

Last updated

Aug 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Longview Eye and VisionGroup PAC ID 5395639959, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Longview Eye & Vision

  • Optometrist
  • Longview, WA
  • NPI 1861535197
  Medicare reassignment Care Compare group NPD
• Longview Eye & Vision

  • Optometrist
  • Cathlamet, WA
  • NPI 1811023732
  NPD
• Woodland Eye & Vision

  • Optometrist
  • Woodland, WA
  • NPI 1215063516
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1558093591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1939",
            "city": "KALAMA",
            "state": "WA",
            "postal_code": "986251700",
            "telephone_number": "360-560-5322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 OCEAN BEACH HWY STE 100",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986324081",
            "telephone_number": "360-636-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Columbia St Ste A",
            "address_purpose": "LOCATION",
            "city": "Woodland",
            "state": "WA",
            "postal_code": "986748491",
            "country_code": "US",
            "telephone_number": "360-225-1010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANNISTER",
        "first_name": "ELIJAH",
        "middle_name": "ALLAN JACKSON",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD61311755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Layne Baker
• Sadie Baker, CNA
• Tabitha L Baldwin, SUDPT, AAC
• Malea Ball
• Karyn Banke, OTR/L
• Divya Bappanad, MD
• Paul Rhoniel Evangelista Barbaza, M.D.
• Jennifer Lyn Bard, MD
• Carmen Lynn Barker
• Elaysia Barker, AAC

• Optometrist in Longview, WA
• Providers in Longview, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.