Provider Demographics
NPI:1669494233
Name:TUFTE, MARK G (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:TUFTE
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 1:1801 45TH ST S STE G
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-0801
Mailing Address - Country:US
Mailing Address - Phone:701-492-3937
Mailing Address - Fax:701-205-1596
Practice Address - Street 1:1801 45TH ST S STE G
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-0801
Practice Address - Country:US
Practice Address - Phone:701-492-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND415152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
U24809Medicare UPIN