Provider Demographics
NPI:1073623799
Name:COREY, RUST DEE (OD)
Entity Type:Individual
Prefix:DR
First Name:RUST
Middle Name:DEE
Last Name:COREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8333
Mailing Address - Country:US
Mailing Address - Phone:541-553-2474
Mailing Address - Fax:541-553-2162
Practice Address - Street 1:1270 KOT-NUM RD
Practice Address - Street 2:BOX 1209
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-553-2474
Practice Address - Fax:541-553-2162
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8HE616Medicare ID - Type Unspecified