| NPI | 1134500101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOGAN KALE BANISTER Owner/Managing Member 316-640-4180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1856) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2015-08-04 |