MEDICARE: CARIE LYNN STOTESBERY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2707	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285715904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARIE LYNN STOTESBERY OD

Provider Business Mailing Address
First Line	:	109 15TH AVE E
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-2509
Country	:	US
Telephone Number	:	320-762-5112
Fax Number	:	320-763-3297

Provider Business Practice Location Address
First Line	:	109 15TH AVE E
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-2509
Country	:	US
Telephone Number	:	320-762-5112
Fax Number	:	320-763-3297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	01/28/2026

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