Individual
BRYAN BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
949 S GLENDALE ST, WICHITA, KS 67218-3210
(316) 685-2221
(316) 239-2747
Mailing address
237 W HUNTER ST, DERBY, KS 67037-4105
(316) 882-6035
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
Primary
276840
—
Other
Enumeration date
10/11/2023
Last updated
10/11/2023
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