| NPI | 1508207176 |
|---|---|
| Former Name | KIMBERLY LYNN LUST |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-2223) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60373324) |
| 152W00000X Optometrist (Licence: ID ODP-100315) | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2020-11-04 |