Physician Compare National (NPI:1750392742)

HEALTHCARE PROVIDER: RYAN LEE HIESTERMAN O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1750392742
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557251592
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170606001669
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HIESTERMAN
	Individual professional last name
Provider First Name	RYAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	OD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OHIO STATE UNIVERSITY - COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SMITHVILLE EYE CENTER LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1254338353
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	9
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	5900 NW 63RD TER
	Group Practice or individual's line 1 address
City	KANSAS CITY
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	641513319
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8165871320
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y