Individual
KYLE M OTTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
200 S 5TH ST, BISMARCK, ND 58504-5675
(701) 222-3937
(701) 222-8805
Mailing address
200 S 5TH ST, BISMARCK, ND 58504-5675
(701) 222-3937
(701) 222-8805
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
714
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1450928
—
ND
Enumeration date
08/29/2013
Last updated
12/15/2020
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