Provider Demographics
NPI:1558328617
Name:BJORK, NATHAN R (OD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:R
Last Name:BJORK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3868
Mailing Address - Country:US
Mailing Address - Phone:513-424-0339
Mailing Address - Fax:513-424-4910
Practice Address - Street 1:315 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3868
Practice Address - Country:US
Practice Address - Phone:513-424-0339
Practice Address - Fax:513-424-4910
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5104T2003174400000X
OH5104 T2003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180044530OtherRAILROAD MEDICARE
KY77000313Medicaid
IN200320880Medicaid
OH2226308Medicaid
OH651160826029OtherCARESOURCE
00000019393OtherCEI BCBS
OH000000270789OtherMEC BCBS
OH4044143Medicare PIN
OH4044141Medicare PIN
OH651160826029OtherCARESOURCE
00000019393OtherCEI BCBS
IN200320880Medicaid