Provider Demographics
NPI:1790523488
Name:DUST, ANDREW THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:THOMAS
Last Name:DUST
Suffix:
Gender:M
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0550
Mailing Address - Country:US
Mailing Address - Phone:618-942-5465
Mailing Address - Fax:618-942-7042
Practice Address - Street 1:3121 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3785
Practice Address - Country:US
Practice Address - Phone:618-942-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist