Organization
PATJAC INC.
Active
Other names
Pearle Vision
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAT KANE (OWNER/OPTICIAN)
(320) 252-0509
Entity
Organization
Contact information
Practice address
1301 33RD ST S, STE 104, SAINT CLOUD, MN 56301-9668
(320) 252-0509
(320) 252-5386
Mailing address
1301 33RD ST S STE 104, SAINT CLOUD, MN 56301-9668
(320) 252-0509
(320) 252-5386
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-00759
MEDICA
MN
01
—
562G3PE
BCBS
MN
01
—
563G3PE
BCBS
MN
01
—
65377
HEALTHPARTNERS
MN
05
—
832255400
—
MN
01
—
J738
UCARE
MN
Enumeration date
07/19/2006
Last updated
06/21/2018
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