NPI 1154551828 · live from the CMS NPI Registry
Logan Kale Banister, O.D.
Optometrist in Derby, KS. National Provider Identifier 1154551828, active.
NPI record
| NPI | 1154551828 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 1626 E Madison Ave, Derby, KS 67037 |
| Practice phone | 316-788-1535 |
| Enumerated | July 16, 2009 |
| Last updated | August 28, 2009 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 1856 (KS) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.