Individual
DR. KIMBERLY LYNN LUST RUEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1621 MARKET PLACE DR, GREAT FALLS, MT 59404-3480
(406) 454-2202
(406) 452-1020
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD60373324
WA
152W00000X
Optometrist
ODP-100315
ID
152W00000X
Optometrist
Primary
OPT-OPT-LIC-2223
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508207176
—
ID
05
—
1508207176
—
MT
05
—
1508207176
—
OR
05
—
2038492
—
WA
Enumeration date
07/11/2013
Last updated
11/04/2020
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