Andrew Lee Rust, O.D.
Individual provider Active NPI Optometrist · Plover, WI
NPI 1891802005 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891802005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2810 (WI)
- Practice address
- 250 Crossroads Dr
Plover, WI 54467-4124 - Phone
- (715) 345-9588
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Ohio State University - College of Optometry, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
250 Crossroads Dr
Plover, WI 54467-4124
Phone (715) 345-9588
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051230000609 | WI | Practitioner - Optometry | 9335161587 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2810 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Andrew L Rust Optometrist SC | Current |
Accepting new patients |
Locations
250 Crossroads Dr
Plover, WI 54467
Phone (715) 345-7870
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2810 | WI | Yes |
Addresses
Primary practice location
250 Crossroads Dr
Plover, WI 54467-4124
Mailing address
1510 Ashwood Dr
Plover, WI 54467-2466
Phone (715) 341-6618
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38610300 | Medicaid | WI |
Other providers in Plover, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.