Healthcare Provider Details

I. General information

NPI: 1669885422
Provider Name (Legal Business Name): KRYSTAL LEIGH ECKSTEIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S
FARGO ND
58103-5800
US

IV. Provider business mailing address

2400 32ND AVE S
FARGO ND
58103-5800
US

V. Phone/Fax

Practice location:
  • Phone: 701-461-5100
  • Fax: 701-234-8710
Mailing address:
  • Phone: 701-461-5100
  • Fax: 701-234-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number840
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3379
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: