Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046008917 | IL |
NPI | 1003874421 |
---|---|
Provider Name | Dr. Cynthia B. Bjorseth |
First Address | Naperville, IL 60564-5107 |
Second Address | Naperville, IL 60564-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T37702 | (02) | IL |