Individual
DR. LOGAN KALE BANISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1626 E MADISON AVE, DERBY, KS 67037-2076
(316) 788-1535
(316) 788-1596
Mailing address
1626 E MADISON AVE, DERBY, KS 67037-2076
(316) 788-1535
(316) 788-1596
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1856
KS
Other
Enumeration date
07/16/2009
Last updated
08/28/2009
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