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Individual

MS. TERESA LYNN LISBURG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OPTICIAN

Contact information

Practice address
1404 33RD ST SW, SUITE 1, FARGO, ND 58103-3482
(701) 212-0758
Mailing address
1404 33RD STREET SOUTHWEST, SUITE 1, FARGO, ND 58103
(701) 212-0758

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary

Other

Enumeration date
09/18/2012
Last updated
09/18/2012
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