| Optometry Clinic, Pc | |
| 28 2nd St Nw, Kenmare, ND 58746-7114 | |
| (701) 385-4004 | |
| (701) 385-4005 | 
| Full Name | Optometry Clinic, Pc | 
|---|---|
| Type | Facility | 
| Speciality | Optometrist | 
| Location | 28 2nd St Nw, Kenmare, North Dakota | 
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1225686827 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Primary | 
| Provider Name | Tesha M Gustafson | 
|---|---|
| Provider Type | Practitioner - Optometry | 
| Provider Identifiers | NPI Number: 1467807230 PECOS PAC ID: 5597053207 Enrollment ID: I20161012002891 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Optometry Clinic, Pc Po Box 1597, Stanley, ND 58784-1551 Ph: (701) 629-0208 | Optometry Clinic, Pc 28 2nd St Nw, Kenmare, ND 58746-7114 Ph: (701) 385-4004 | 
| Optometry Clinic Of Kenmare Optometrist Medicare: Not Enrolled in Medicare Practice Location: 28 2nd St Nw, Kenmare, ND 58746 Phone: 701-385-4004 Fax: 701-385-4005 | |
| Tesha Gustafson, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 28 2nd St Nw, Kenmare, ND 58746 Phone: 701-385-4004 Fax: 701-385-4005 | |
| Dr. David Paul Colby, O.D. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 28 2nd St Nw, Kenmare, ND 58746 Phone: 701-385-4004 Fax: 701-385-4005 |