Healthcare Provider Details

I. General information

NPI: 1912232000
Provider Name (Legal Business Name): HANS OYSTEIN BJORN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34719 6TH AVE S
FEDERAL WAY WA
98003-8714
US

IV. Provider business mailing address

34719 6TH AVE S
FEDERAL WAY WA
98003-8714
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-3969
  • Fax:
Mailing address:
  • Phone: 253-874-3969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60204244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: