Teresa Lynn Lisburg, optician
Technician/Technologist, Optician in Fargo, ND. Individual provider (NPI-1).
NPI number1770833675
StatusActive
Last updated in NPPESSep 18, 2012
Details
- NPI
- 1770833675
- Entity type
- Individual (NPI-1)
- Name
- Ms. Teresa Lynn Lisburg
- Credential
- optician
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 18, 2012
- Last updated
- Sep 18, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | – | – | Yes |
Practice location
1404 33rd St SwSuite 1
Fargo, ND 58103-3482
Phone 701-212-0758
Mailing address
1404 33rd Street SouthwestSuite 1
Fargo, ND 58103
Phone 701-212-0758
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