Organization
DERBY EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOGAN KALE BANISTER O.D. (OWNER/MANAGING MEMBER)
(316) 640-4180
Entity
Organization
Contact information
Practice address
1626 E MADISON AVE, DERBY, KS 67037-2076
(316) 640-4180
Mailing address
1626 E MADISON AVE, DERBY, KS 67037-2076
(316) 640-4180
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1856
KS
Other
Enumeration date
06/15/2015
Last updated
08/04/2015
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