Healthcare Provider Details

I. General information

NPI: 1285715904
Provider Name (Legal Business Name): CARIE LYNN STOTESBERY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 15TH AVE E
ALEXANDRIA MN
56308-2509
US

IV. Provider business mailing address

12022 MINNESOURI RD NW
ALEXANDRIA MN
56308-2692
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-5112
  • Fax:
Mailing address:
  • Phone: 320-808-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2707
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: