Provider Demographics
NPI:1407187065
Name:BJORLIE, SELINA (OD)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:BJORLIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 LILAC LN N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1703
Mailing Address - Country:US
Mailing Address - Phone:701-235-1333
Mailing Address - Fax:
Practice Address - Street 1:2826 LILAC LN N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1703
Practice Address - Country:US
Practice Address - Phone:701-235-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND509152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist