Provider Demographics
NPI:1487726535
Name:BJORK, DAVID (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BJORK
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 1:1674 OLD SCHOOLHOUSE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1396
Mailing Address - Country:US
Mailing Address - Phone:262-354-0410
Mailing Address - Fax:262-567-0744
Practice Address - Street 1:1674 OLD SCHOOLHOUSE RD STE 101
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1396
Practice Address - Country:US
Practice Address - Phone:262-354-0410
Practice Address - Fax:262-567-0744
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3017-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38726800Medicaid
WI1376724377OtherNPI GROUP NUMBER
WI1376724377OtherNPI GROUP NUMBER