Healthcare Provider Details

I. General information

NPI: 1053696104
Provider Name (Legal Business Name): EMILY KAY BJORE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 VIKINGS PKWY STE B
EAGAN MN
55121-1187
US

IV. Provider business mailing address

855 VIKINGS PKWY STE B
EAGAN MN
55121-1187
US

V. Phone/Fax

Practice location:
  • Phone: 651-280-4420
  • Fax: 651-280-4155
Mailing address:
  • Phone: 651-280-4420
  • Fax: 651-280-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3375
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: