Organization
OCONOMOWOC VISION CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MARK BJORK O.D. (OWNER/OPTOMETRIST)
(262) 567-2295
Entity
Organization
Contact information
Practice address
1674 OLD SCHOOLHOUSE RD, SUITE 101, OCONOMOWOC, WI 53066-1396
(262) 567-2295
(262) 567-0744
Mailing address
1674 OLD SCHOOLHOUSE RD, SUITE 101, OCONOMOWOC, WI 53066-1396
(262) 567-2295
(262) 567-0744
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3017
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487726535
INDIVIDUAL NPI NUMBER
—
05
—
38726800
—
WI
Enumeration date
11/18/2007
Last updated
05/10/2013
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