Organization
KISTER EYECARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN J. KISTER O.D. (DOCTOR, OWNER)
(307) 856-6531
Entity
Organization
Contact information
Practice address
400 E ADAMS AVE, RIVERTON, WY 82501-4413
(307) 856-6531
(307) 856-1306
Mailing address
400 E ADAMS AVE, RIVERTON, WY 82501-4413
(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
05
—
104032400
—
WY
01
—
1897-001
BCBS
WY
01
—
4590585
MEDICARE
WY
Enumeration date
02/21/2008
Last updated
12/07/2012
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