Provider Demographics
NPI:1689921553
Name:PIESTER, ANDREW W (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:PIESTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WEST C AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1313
Mailing Address - Country:US
Mailing Address - Phone:620-532-3154
Mailing Address - Fax:620-532-5662
Practice Address - Street 1:104 WEST C AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1313
Practice Address - Country:US
Practice Address - Phone:620-532-3154
Practice Address - Fax:620-532-5662
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200966630AMedicaid
KSP01102034OtherRR MEDICARE
KSP01102034OtherRR MEDICARE