Provider Demographics
NPI:1508968108
Name:BUSTER, KRISTINA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LEE
Last Name:BUSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9175 GROUSE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1050
Mailing Address - Country:US
Mailing Address - Phone:406-829-0971
Mailing Address - Fax:
Practice Address - Street 1:3555 MULLAN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5125
Practice Address - Country:US
Practice Address - Phone:406-829-8516
Practice Address - Fax:406-829-8527
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT27468OtherMES
MT49057OtherDAVIS VISION
MT37880OtherAVESIS
MT927901OtherBLOCK VISION
MT000027761OtherBLUE CROSS BLUE SHIELD
MT0482358Medicaid
MT20253OtherSPECTERA
MT000027761OtherBLUE CROSS BLUE SHIELD
MT0482358Medicaid