Provider Demographics
NPI:1588799761
Name:BJORNGAARD, KAREN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:BJORNGAARD
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 1:150 17TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0321
Mailing Address - Country:US
Mailing Address - Phone:507-288-6964
Mailing Address - Fax:507-252-5307
Practice Address - Street 1:150 17TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0321
Practice Address - Country:US
Practice Address - Phone:507-288-6964
Practice Address - Fax:507-252-5307
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4C407GIOtherBCBS
MN691325300Medicaid
4C408BJOtherBCBS
MN101634OtherUCARE
MN691325300Medicaid
410000766Medicare ID - Type UnspecifiedEXAMINATIONS
4C407GIOtherBCBS
421598946OtherEIN
MN691325300Medicaid