Derby Eyecare LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

1856 Issued in KS

Legal business name

DERBY EYECARE LLC

Practice address

1626 E Madison Ave
Derby, KS 67037-2076

Phone

(316) 640-4180

NPI assigned

Jun 15, 2015

Last updated

Aug 4, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Logan Kale Banister, O.D.NPI 1154551828

Title

Owner/Managing Member

Phone

(316) 640-4180

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Logan Kale Banister, O.D.

  • Optometrist
  • Derby, KS
  • NPI 1154551828
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1134500101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 E MADISON AVE",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670372076",
            "telephone_number": "316-640-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 E MADISON AVE",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670372076",
            "telephone_number": "316-640-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERBY EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-15",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "BANISTER",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_middle_name": "KALE",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "316-640-4180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Derby, KS
• Providers in Derby, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.