Individual
DR. RYAN LEE HIESTERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
629 W CRAWFORD ST, CLAY CENTER, KS 67432-2337
(785) 632-6100
(785) 630-5830
Mailing address
8305 MELROSE DR, LENEXA, KS 66214-1629
(785) 632-6100
(913) 340-9880
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1656
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
065087
BLUE CROSS BLUE SHIELD KS
KS
05
—
200259350B
—
KS
01
—
47-0944087
SUPERIOR VISION
KS
01
—
481170
FIRSTGUARD
KS
01
—
651020
BCBS OF KS PIN #
KS
01
—
P00173182
RAILROAD MEDICARE (24K)
KS
Enumeration date
08/11/2006
Last updated
01/12/2023
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