Individual
DR. IAN THORSTEN KIRSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
121 S MAIN AVE, AZTEC, NM 87410-2120
(505) 333-7278
(505) 395-9287
Mailing address
121 S MAIN AVE, AZTEC, NM 87410-2120
(505) 333-7278
(505) 395-9287
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
424
NM
152WC0802X
Corneal and Contact Management Optometrist
424
NM
152WL0500X
Low Vision Rehabilitation Optometrist
424
NM
152WS0006X
Sports Vision Optometrist
424
NM
152WV0400X
Vision Therapy Optometrist
424
NM
152WX0102X
Occupational Vision Optometrist
424
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23623331
—
NM
Enumeration date
04/10/2006
Last updated
03/17/2018
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