Organization
JEROME D. POLAND, M.D., LTD
Active
Parent organization
JEROME D. POLAND, M.D., LTD
Other names
Crosby Eye Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
JEROME D. POLAND, M.D., LTD
Authorized official
DR. JEROME D POLAND MD (MEDICAL DIRECTOR)
(218) 546-5108
Entity
Organization
Contact information
Practice address
43500 MIGIZI DR, ONAMIA, MN 56359-2241
(320) 532-4163
(320) 532-4354
Mailing address
1 3RD AVE NE, CROSBY, MN 56441-1665
(218) 546-5108
(218) 546-5736
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
2807770001
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261527400
—
MN
01
—
566R0CR
BLUE PLUS DISP
MN
01
—
85038PO
BLUE CROSS/BLUE SHIELD MN
MN
01
—
CG9827
PALMETTO GBA
MN
Enumeration date
10/24/2007
Last updated
07/12/2013
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