LOGAN K BANISTER

Dr LOGAN K BANISTER is a male medical professional, specializing in Optometry. He graduated in 2009 from Southern College Of Optometry.

Contact

1626 E MADISON AVE
DERBRY EYE CARE
DERBY
KS
670372076

Tel:

LOGAN K BANISTER Information

Npi 1154551828
Pac Id 0840346987
Professional Enrollment Id I20090915000500
Last Name BANISTER
First Name LOGAN
Middle Name K
Suffix
Gender M
Credential
Medical School Name SOUTHERN COLLEGE OF OPTOMETRY
Graduation Year 2009
Primary Specialty OPTOMETRY
Secondary Specialty 1
Secondary Specialty 2
Secondary Specialty 3
Secondary Specialty 4
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Organization Legal Name
Group Practice Pac Id
Number Of Group Practice Members
Line 1 Street Address 1626 E MADISON AVE
Line 2 Street Address DERBRY EYE CARE
Marker Of Address Line 2 Suppression
City DERBY
State KS
Zip Code 670372076
Phone Number
Hospital Affiliation Ccn 1
Hospital Affiliation Lbn 1
Hospital Affiliation Ccn 2
Hospital Affiliation Lbn 2
Hospital Affiliation Ccn 3
Hospital Affiliation Lbn 3
Hospital Affiliation Ccn 4
Hospital Affiliation Lbn 4
Hospital Affiliation Ccn 5
Hospital Affiliation Lbn 5
Professional Accepts Medicare Assignment Y

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