Elijah Allan Jackson Bannister, OD
Individual provider Active NPI Optometrist · Longview, WA
NPI 1558093591 · NPPES record last updated Aug 2, 2022
Key facts
- NPI
- 1558093591
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OD61311755 (WA)
- Practice address
- 820 Ocean Beach Hwy Ste 100
Longview, WA 98632-4081 - Phone
- (360) 636-2020
- NPI assigned
- Jun 28, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- 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 Vision
Practice addresses (Care Compare)
820 Ocean Beach Hwy
Suite 100
Longview, WA 98632-4081
Phone (360) 636-2020
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 26 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221026001582 | WA | Practitioner - Optometry | 1658747001 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodland Eye & Vision | Optometrist | Current | Accepting new patients |
| Longview Eye & Vision | Optometrist | Current | Accepting new patients |
| Longview Eye & Vision | Optometrist | Current |
Accepting new patients |
Locations
820 Ocean Beach Hwy
Ste 100
Longview, WA 98632
Phone (360) 636-2020
500 Columbia St
Ste A
Woodland, WA 98674
Phone (360) 225-1010
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OD61311755 | WA | Yes |
Addresses
Primary practice location
820 Ocean Beach Hwy Ste 100
Longview, WA 98632-4081
Mailing address
PO Box 1939
Kalama, WA 98625-1700
Phone (360) 560-5322
Other practice location 1
500 Columbia St Ste A
Woodland, WA 98674-8491
Phone (360) 225-1010
Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.