Organization
IAN T KIRSTE OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IAN T KIRSTE OD (OPTOMETRIST)
(505) 326-7654
Entity
Organization
Contact information
Practice address
121 S MAIN AVE, AZTEC, NM 87410-2120
(505) 333-7278
(505) 395-9287
Mailing address
4323 E MAIN ST, FARMINGTON, NM 87402-8621
(505) 326-7654
(505) 356-7656
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
424
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E5476
—
NM
Enumeration date
04/11/2007
Last updated
10/16/2017
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