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General NPI Number Information
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NPI Number | 1740454396
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Entity Type | Organization
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Legal Business Name | KRISTINA L. BUSTER, O.D., P.C.
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 100 COURTHOUSE DR STE. F
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City | SALMON
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State | ID
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Zip | 83467-3919
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Country | US
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Telephone | 208-756-3777
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Fax | 208-756-3778
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Provider Business Mailing Address
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Address Line | 100 COURTHOUSE DR STE. F
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City | SALMON
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State | ID
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Zip | 83467-3919
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Country | US
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Telephone | 208-756-3777
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Fax | 208-756-3778
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTINA LEE BUSTER
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Credential | O.D.
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Telephone | 208-756-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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