Derby Eyecare LLC

NPI #1134500101 in Derby, Kansas

Provider Information

NPI Number: 1134500101
Entity Type: Organization
Organization Name: Derby Eyecare LLC
Primary Specialty: Optometrist
Enumeration Date: Jun 15, 2015
Last Updated: Aug 4, 2015

Practice Location

Address: 1626 E MADISON AVE
City: Derby
State: Kansas
ZIP Code: 67037-2076
Phone: (316) 640-4180

Authorized Official

Name: DR. LOGAN KALE BANISTER, O.D.
Title: OWNER/MANAGING MEMBER
Phone: (316) 640-4180

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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