Andrew L Rust Optometrist SC
Organization Active NPI Primary Care Clinic/Center · Plover, WI
NPI 1164655882 · NPPES record last updated Aug 27, 2009
Key facts
- NPI
- 1164655882
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 2810 (WI)
- Legal business name
- ANDREW L RUST OPTOMETRIST SC
- Practice address
- 250 Crossroads Dr
Plover, WI 54467-4124 - Phone
- (715) 345-9588
- NPI assigned
- Aug 27, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Andrew Rust, O.D.
- Title
- Owner/President
- Phone
- (715) 341-3318
Practitioners 1
-
Andrew Lee Rust, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090929000234 | WI | Part B Supplier - Clinic/Group Practice | 1850447129 |
Receives reassigned benefits from 1 practitioner Practice locations: Plover, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 2810 | WI | Yes |
Addresses
Primary practice location
250 Crossroads Dr
Plover, WI 54467-4124
Mailing address
1510 Ashwood Dr
Plover, WI 54467-2466
Other providers in Plover, WI
- 4U Adult Day Service, LLC
- Aligned Health Chiropractic
- Alpine Medical Supply, Inc
- Alpine Supply, LLC
- Tyler McLaine Alt
- Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc.
- Aurora Pharmacy Inc
- Margaret E Bach
- Katie Bass
- Marvin M Bauer
All providers in Plover, WI · Primary Care Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.