Provider Demographics
NPI:1912382086
Name:LUSTER, WHITNEY (OD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:LUSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W COLLEGE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 W COLLEGE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4701
Practice Address - Country:US
Practice Address - Phone:813-886-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist