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General NPI Number Information
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NPI Number | 1336125319
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Entity Type | Individual
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Provider Name | BENJAMIN J KISTER OD
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 400 E ADAMS AVE
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City | RIVERTON
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State | WY
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Zip | 82501-4413
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Country | US
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Telephone | 307-856-6531
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Fax | 307-856-1306
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Provider Business Mailing Address
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Address Line | PO BOX 873
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City | RIVERTON
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State | WY
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Zip | 82501-0116
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Country | US
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Telephone | 307-856-6531
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Fax | 307-856-1306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 115T
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License Number State | WY
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