Individual
KRISTIN F ENGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4731 13TH AVE S, FARGO, ND 58103-7205
(701) 281-2746
(701) 281-2747
Mailing address
4607 TIMBERLINE DR S, FARGO, ND 58104
(701) 730-6168
(701) 281-2747
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2512
MN
152W00000X
Optometrist
Primary
582
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60597
—
ND
Enumeration date
09/15/2006
Last updated
09/29/2017
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