Healthcare Provider Details

I. General information

NPI: 1477583466
Provider Name (Legal Business Name): JOY M QUITBERG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY M JOHNSON OD

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/09/2026
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 PROSPERITY WAY SUITE #114
FARGO ND
58104
US

IV. Provider business mailing address

5120 PROSPERITY WAY SUITE #114
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-404-9096
  • Fax: 701-436-9223
Mailing address:
  • Phone: 701-404-9096
  • Fax: 701-436-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number645
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2897
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: