Provider Demographics
NPI:1508168949
Name:RUSCH, KRISTEN LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LYNN
Last Name:RUSCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:HAMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1235 S REED RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-1904
Mailing Address - Country:US
Mailing Address - Phone:765-459-5117
Mailing Address - Fax:
Practice Address - Street 1:1235 S REED RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-459-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003649A152W00000X
NE1432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist