Organization
JEROME D. POLAND, M.D., LTD
Active
Parent organization
CROSBY EYE CLINIC
Other names
Crosby Eye Clinic/Baxter
Organization subpart
Yes
Provider details
NPI number
Legal business name
CROSBY EYE CLINIC
Authorized official
DR. JEROME D POLAND MD (MEDICAL DIRECTOR)
(218) 546-5108
Entity
Organization
Contact information
Practice address
7636 DESIGN RD STE 105, BAXTER, MN 56425-8678
(218) 825-1976
(218) 828-9869
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
2807770002
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261527400
—
MN
01
—
566R0CR
BLUE PLUS DISPENSING
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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