PATJAC INC. (NPI# 1275552382) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275552382 |
| Entity Type | Organization |
| Organization Name | PATJAC INC. |
| Other Organization Name | PEARLE VISION |
| Practice Address |
1301 33rd St S Ste 104 Saint Cloud MN 56301-9668 |
| Mailing Address |
1301 33rd St S Ste 104 Saint Cloud MN 56301-9668 |
| Practice Telephone | 3202520509 |
| Practice Fax Number | 3202525386 |
| Mailing Telephone | 3202520509 |
| Mailing Fax Number | 3202525386 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2018-06-21 |
| Authorized Official Name | MR. PAT KANE (OWNER/OPTICIAN) |
| Authorized Official Telephone | 3202520509 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | UCARE | J738 | 01 |
| MN | BCBS | 562G3PE | 01 |
| MN | HEALTHPARTNERS | 65377 | 01 |
| MN | 832255400 | 05 | |
| MN | BCBS | 563G3PE | 01 |
| MN | MEDICA | 21-00759 | 01 |
| Other Name | Type Code |
|---|---|
| Pearle Vision | Doing Business As Name - Organization |
| Street Address |
1301 33RD ST S STE 104 |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56301-9668 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013912559 | Kristen J Heffern | Nurse Practitioner | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2005-06-20 |
| 1649885922 | Amal Mohamed Farah | Family Medicine | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2020-09-13 |
| 1275163388 | Jamie Rae Pohlmann | Physical Therapist | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2020-01-17 |
| 1679133052 | Stephanie Marie Gagelin | Physician Assistant | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2019-06-18 |
| 1063935955 | Amanda Marilyn Michalski | Physician Assistant | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2017-07-21 |
| 1669994315 | Centracare Clinic | Clinic/Center | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2017-07-14 |
| 1568811529 | Carly Elizabeth Schmitt | Physical Therapist | 1301 33rd St S, Suite 210, Saint Cloud, MN 56301-9668 | 2016-06-09 |
| 1548616576 | Brianna Thour | Physical Therapist | 1301 33rd St S, Suite 210, Saint Cloud, MN 56301-9668 | 2016-05-09 |
| 1427439454 | Noah Helgerson | Physical Therapist | 1301 33rd St S, Suite 210, Saint Cloud, MN 56301-9668 | 2015-06-16 |
| 1205225224 | Jamie Marie Dockendorf | Physician Assistant | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2015-01-14 |
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|---|---|---|---|---|
| 1013528207 | Stephen Sean Jenkins | Psychologist | 720 Fourth Ave. S., Eastman Hall 305, Saint Cloud, MN 56301 | 2020-08-12 |
| 1316453442 | Amber Grengs | Behavior Technician | 3721 23rd St S Ste 201, Saint Cloud, MN 56301 | 2017-12-27 |
| 1124532999 | Ashley Aune Lewandowski | Chiropractor | 3333 W. Division St. Suite 122a, St. Cloud, MN 56301 | 2017-11-30 |
| 1962923680 | Inspired By You Home Care, LLC | Home Health | 2700 1st Street N, Suite 202, St Cloud, MN 56301 | 2017-07-03 |
| 1487189569 | Brett Finberg | Pharmacy Technician | 141 33rd Ave South, Saint Cloud, MN 56301 | 2017-04-26 |
| 1629513221 | Robert Schug | Pharmacy Technician | 141 33rd Ave S, Saint Cloud, MN 56301 | 2017-01-05 |
| 1649726910 | Rebecca Hoffman Pllc | Specialist | 3400 1st Street N, Suite 300, St. Cloud, MN 56301 | 2016-08-28 |
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| 1063759546 | Grand St Paul Cvs, LLC | Durable Medical Equipment & Medical Supplies | 2420 Division St, St. Cloud, MN 56301 | 2013-01-03 |
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| Taxonomy Code | 156FX1800X |
| Grouping | Eye and Vision Services Providers |
| Classification | Technician/Technologist |
| Specialization | Optician |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225210867 | Cassandra K Amundson | Technician/Technologist | 900 West Saint Germain Street, Saint Cloud, MN 56301-3401 | 2007-12-05 |
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| 1467451070 | Timothy Gerald Billig | Technician/Technologist | 20 9th Ave N, Saint Cloud, MN 56303-4626 | 2005-07-15 |
| 1063762359 | Wal-mart Stores Inc | Technician/Technologist | 3601 2nd St S, Saint Cloud, MN 56301-3762 | 2012-09-13 |
| 1023278322 | Billig Opticians | Technician/Technologist | 20 9th Ave N, Saint Cloud, MN 56303-4626 | 2008-06-11 |
| 1811069511 | Midwest Vision Centers Inc | Technician/Technologist | 2824 W Division St, Saint Cloud, MN 56301-3800 | 2006-11-15 |
| 1609968791 | Wal-mart Stores East, Lp | Technician/Technologist | 4400 13th St, Saint Cloud, FL 34769-6763 | 2006-09-28 |
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| 1942622089 | Wal-mart Stores, Inc. | Technician/Technologist | 9300 East Point Douglas Rd S, Cottage Grove, MN 55016 | 2014-01-08 |
| 1851712384 | Marshall Allan Daly | Technician/Technologist | 2484 University Ave W, Saint Paul, MN 55114-1735 | 2013-12-31 |
| 1174966683 | David Yang | Technician/Technologist | 987 Oday St S, Maplewood, MN 55119-5953 | 2013-04-15 |
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| City | SAINT CLOUD |
| Zip Code | 56301 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.