Provider Demographics
NPI:1871881656
Name:RISTVEDT, DEBORAH GESS (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GESS
Last Name:RISTVEDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3162
Mailing Address - Country:US
Mailing Address - Phone:605-371-7100
Mailing Address - Fax:605-371-7199
Practice Address - Street 1:2600 JEFFERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3410
Practice Address - Country:US
Practice Address - Phone:320-762-2166
Practice Address - Fax:605-371-7199
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54574207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology