Lust Rueb, Kimberly Lynn
Lust Rueb, Kimberly Lynn is an individual health care provider with primary practice located at 1621 Market Place Dr , Great Falls MT 59404-3480. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Lust Rueb, Kimberly Lynn can be contacted via phone (406) 454-2202.Contact Information
Primary practice address
1621 Market Place Dr
Great Falls MT 59404-3480
Phone: (406) 454-2202
Fax: (406) 452-1020
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OD60373324 | Washington |
| Eye and Vision Services Providers / Optometrist | 152W00000X | ODP-100315 | Idaho |
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPT-OPT-LIC-2223 | Montana |
Profile Details
| NPI number | 1508207176 |
|---|---|
| LBN Legal business name | Lust Rueb, Kimberly Lynn |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 11th, 2013 |
| Last updated | Nov 4th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508207176 | NPPES |
| Idaho | MEDICAID | 1508207176 | |
| Idaho | MEDICAID | 2038492 | |
| Idaho | MEDICAID | 1508207176 | |
| Idaho | MEDICAID | 1508207176 |
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