Provider Demographics
NPI:1982702247
Name:RASMUSSEN, TRACYE DAWN (OD)
Entity Type:Individual
Prefix:MS
First Name:TRACYE
Middle Name:DAWN
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TRACYE
Other - Middle Name:DAWN
Other - Last Name:EISELT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:120 N BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-345-5087
Mailing Address - Fax:507-345-1151
Practice Address - Street 1:120 N BROAD STREET
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-345-5087
Practice Address - Fax:507-345-1151
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN004146700Medicaid