Individual
DR. BENJAMIN J KISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
400 E ADAMS AVE, RIVERTON, WY 82501-4413
(307) 856-6531
(307) 856-1306
Mailing address
PO BOX 873, RIVERTON, WY 82501-0116
(307) 856-6531
(307) 856-1306
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
115T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1897001
BLUE CROSS BLUE SHIELD
WY
Enumeration date
12/21/2005
Last updated
04/08/2008
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