Healthcare Provider Details

I. General information

NPI: 1003874421
Provider Name (Legal Business Name): CYNTHIA B. BJORSETH O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 ENGLISH ROW AVE STE 209
NAPERVILLE IL
60564-5107
US

IV. Provider business mailing address

3027 ENGLISH ROW AVE STE 209
NAPERVILLE IL
60564-5107
US

V. Phone/Fax

Practice location:
  • Phone: 630-922-2661
  • Fax: 630-470-6979
Mailing address:
  • Phone: 630-922-2661
  • Fax: 630-470-6979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: