Provider Demographics
NPI:1033092747
Name:DUSEK, MIRANDA (OD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:DUSEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1621
Mailing Address - Country:US
Mailing Address - Phone:701-520-4616
Mailing Address - Fax:
Practice Address - Street 1:415 HILL AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1001
Practice Address - Country:US
Practice Address - Phone:701-352-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist