JEROME D. POLAND, M.D., LTD (NPI# 1285813451) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285813451 |
| Entity Type | Organization |
| Organization Name | JEROME D. POLAND, M.D., LTD |
| Other Organization Name | CROSBY EYE CLINIC |
| Practice Address |
43500 Migizi Dr Onamia MN 56359-2241 |
| Mailing Address |
1 3rd Ave Ne Crosby MN 56441-1665 |
| Practice Telephone | 3205324163 |
| Practice Fax Number | 3205324354 |
| Mailing Telephone | 2185465108 |
| Mailing Fax Number | 2185465736 |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2013-07-12 |
| Authorized Official Name | DR. JEROME D POLAND (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2185465108 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | JEROME D. POLAND, M.D., LTD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | 2807770001 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE CROSS/BLUE SHIELD MN | 85038PO | 01 |
| MN | BLUE PLUS DISP | 566R0CR | 01 |
| MN | 261527400 | 05 | |
| MN | PALMETTO GBA | CG9827 | 01 |
| Other Name | Type Code |
|---|---|
| Crosby Eye Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295914463 | Jerome D. Poland, M.d., Ltd | Optometrist | 7636 Design Rd Ste 105, Baxter, MN 56425-8678 | 2007-10-24 |
| 1366621534 | Jerome D. Poland, M.d., Ltd | Specialist | 200 Elm St N, Onamia, MN 56359-7901 | 2007-10-24 |
| Street Address |
43500 MIGIZI DR |
| City | ONAMIA |
| State | MN |
| Zip Code | 56359-2241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518943885 | Donald V Gunderson | Internal Medicine | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2005-12-19 |
| 1801366695 | Tanya Ann Doyle | Counselor | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2018-12-05 |
| 1134690969 | Christina Marie Irrgang-wade | Counselor | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2018-12-05 |
| 1023583408 | Sara Graff | Dental Hygienist | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2018-10-11 |
| 1558840389 | Briana Marie Rosvold | Registered Nurse | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2018-08-13 |
| 1972039956 | Laura Lee | Registered Nurse | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2017-05-11 |
| 1831624857 | Mille Lacs Band of Ojibwe Indians | Clinic/Center | 43500 Migizi Dr, Onamia, MN 56359 | 2017-04-27 |
| 1447625041 | Casandra Lynn Helmin | Registered Nurse | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2015-12-08 |
| 1598139677 | Alicia Remer | Registered Nurse | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2015-11-30 |
| 1396160826 | Kelsay Mary Peterson | Dietitian, Registered | 43500 Migizi Dr, Onamia, MN 56359-2241 | 2014-02-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588185417 | Stephanie Lynn Conzet | Registered Nurse | 200 North Elm Street North, Mille Lacs Family Clinic, Onamia, MN 56359 | 2017-06-30 |
| 1760759880 | Joseph Nayquonabe | Counselor | 42273 Twilight Road, Onamia, MN 56359 | 2011-11-17 |
| 1548496060 | Mille Lacs Band of Ojibwe Indians | Substance Abuse Rehabilitation Facility | 17222 Ataage Dr, Onamia, MN 56359 | 2009-06-10 |
| 1831388909 | Mille Lacs Band of Ojibwe Indians | Community/Behavioral Health | 42293 Twilight Rd, Onamia, MN 56359 | 2007-10-15 |
| 1982729364 | Mille Lacs Band of Ojibwe Indians | Pharmacy | 43500 Migizi Drive, Onamia, MN 56359 | 2007-03-21 |
| 1639205370 | Jennifer Lee Hewitt | Registered Nurse | 17230 Noopiming Drive, Onamia, MN 56359 | 2007-02-26 |
| 1164569760 | Betty Nichols | Registered Nurse | 17230 Noopiming Dr., Onaima, MN 56359 | 2007-01-31 |
| 1639224975 | Deanna M Duret | Dietitian, Registered | 200 Elm Street North, Onamia, MN 56359 | 2007-01-25 |
| 1700958881 | Nexus | Community Based Residential Treatment Facility, Mental Illness | 407 130th Avenue South, Onamia, MN 56359 | 2006-11-14 |
| 1780777615 | Diana Ochoa Chu | Psychiatry & Neurology | 407 130th Ave S, Onamia, MN 56359 | 2006-10-02 |
| Find all providers in zip 56359 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493903 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 11995 Business Park Blvd N, Champlin, MN 55316 | 2020-10-02 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1891351268 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1101 E College Dr, Marshall, MN 56258-2366 | 2019-05-11 |
| 1730745100 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1459 W Service Dr, Winona, MN 55987-2512 | 2019-05-11 |
| 1649836016 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1023 E Blue Earth Ave, Fairmont, MN 56031-4076 | 2019-05-11 |
| 1124684592 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1004 18th Ave Nw Ste D, Austin, MN 55912-1993 | 2019-05-11 |
| 1053977421 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1620 Broadway Ave S Ste 4, Rochester, MN 55904-7927 | 2019-05-11 |
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1831651165 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 3366 Oakdale Ave N Ste 140, Robbinsdale, MN 55422-2961 | 2019-04-04 |
| 1538624341 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 9825 Hospital Dr # 106, Maple Grove, MN 55369-4479 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
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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.