Ian T Kirste OD PC
Organization Active NPI Optometrist · Aztec, NM
NPI 1356564736 · NPPES record last updated Oct 16, 2017
Key facts
- NPI
- 1356564736
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 424 (NM)
- Legal business name
- IAN T KIRSTE OD PC
- Practice address
- 121 S Main Ave
Aztec, NM 87410-2120 - Phone
- (505) 333-7278
- Fax
- (505) 395-9287
- NPI assigned
- Apr 11, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Ian T Kirste, OD
- Title
- Optometrist
- Phone
- (505) 326-7654
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 424 | NM | Yes |
Addresses
Primary practice location
121 S Main Ave
Aztec, NM 87410-2120
Mailing address
4323 E Main St
Farmington, NM 87402-8621
Phone (505) 326-7654
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E5476 | Medicaid | NM |
Other providers in Aztec, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.