Provider Demographics
NPI:1275193864
Name:RISBRUDT, NICHOLAS CHRISTIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHRISTIAN
Last Name:RISBRUDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 32ND AVE E STE B
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8490
Mailing Address - Country:US
Mailing Address - Phone:701-566-5390
Mailing Address - Fax:
Practice Address - Street 1:505 32ND AVE E STE B
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8490
Practice Address - Country:US
Practice Address - Phone:701-566-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist