Organization
OPTOMETRY CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TESHA GUSTAFSON OD (OWNER/OPTOMETRIST)
(701) 629-0208
Entity
Organization
Contact information
Practice address
28 2ND ST NW, KENMARE, ND 58746-7114
(701) 385-4004
(701) 385-4005
Mailing address
PO BOX 1597, STANLEY, ND 58784-1551
(701) 629-0208
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
08/28/2019
Last updated
09/18/2020
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