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General NPI Number Information
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NPI Number | 1164857769
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Entity Type | Organization
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Legal Business Name | PERSPECTIVE VISION CARE LLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 105 E WISCONSIN AVE 206
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3058
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Country | US
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Telephone | 262-354-8179
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Fax |
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Provider Business Mailing Address
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Address Line | 105 E WISCONSIN AVE 206
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3058
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Country | US
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Telephone | 262-354-8179
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DAVID BJORK
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Credential | O.D.
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Telephone | 262-705-6958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3017
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License Number State | WI
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