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Organization
PATJAC, INC.
Active
Organization
PATJAC, INC.
Active
Other names
Pearle Vision
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK O KANE OPTICIAN (FRANCHISE OWNER)
(320) 252-2021
Entity
Organization
Contact information
Practice address
4118 W DIVISION ST, SAINT CLOUD, MN 56301-3706
(320) 252-2021
(320) 252-7416
Mailing address
4118 W DIVISION ST, SAINT CLOUD, MN 56301-3706
(320) 252-2021
(320) 252-7416
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102081
COLE
MN
01
—
110495
UCARE
MN
01
—
21-20963
MEDICA
MN
05
—
383663100
—
MN
01
—
65208PE
BCBS
MN
01
—
65209PE
BCBS
MN
01
—
65377
HP
MN
01
—
C02754
WISCONSIN PHY
—
Enumeration date
07/19/2005
Last updated
07/21/2022
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