Provider Demographics
NPI:1942795851
Name:RUSTEMEYER, CAITLIN ANNE (OD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANNE
Last Name:RUSTEMEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ANNE
Other - Last Name:CONDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16618 RIVERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277
Mailing Address - Country:US
Mailing Address - Phone:704-817-3800
Mailing Address - Fax:980-422-0380
Practice Address - Street 1:16618 RIVERSTONE WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-817-3800
Practice Address - Fax:980-422-0380
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2634152W00000X
SC2214152W00000X
CTCT3070152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist