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Individual

TRACIE MALSOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
1695 43RD ST S, FARGO, ND 58103-3317
(701) 235-3937
(701) 356-3937
Mailing address
1695 43RD ST S, FARGO, ND 58103-3317
(701) 235-3937
(701) 356-3937

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
18003360
IN
152W00000X
Optometrist
3046
MN
152W00000X
Optometrist
Primary
642
ND

Other

Enumeration date
05/11/2006
Last updated
09/27/2013
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