Individual
TESHA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
28 2ND ST NW, KENMARE, ND 58746-7114
(701) 385-4004
(701) 385-4005
Mailing address
28 2ND ST NW, KENMARE, ND 58746-7114
(701) 385-4004
(701) 385-4005
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
745
ND
Other
Enumeration date
04/29/2016
Last updated
02/04/2019
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