| Organization Name: | ANDREW L RUST OPTOMETRIST SC |
| NPI Number: | 1164655882 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREW RUST (OWNER/PRESIDENT) |
| Mailing Address: | 250 Crossroads Dr Plover |
| State: | WI US |
| Postal Code: | 544674124 |
| Phone Number: | 7153459588 |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2009 |
| NPI Last Update Date: | 08/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 2810 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |