Patjac, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

PATJAC, INC.

Doing business as

Pearle Vision

Practice address

4118 W Division St
Saint Cloud, MN 56301-3706

Phone

(320) 252-2021

Fax

(320) 252-7416

NPI assigned

Jul 19, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Patrick O Kane, OPTICIAN

Title

Franchise Owner

Phone

(320) 252-2021

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 1

• Pearle Vision Doing business as

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jared Jay Fairbanks, O.D.

  • Optometrist
  • Willmar, MN
  • NPI 1881031524
  NPD (past)
• Sally Beth Jackula, OD

  • Optometrist
  • Saint Cloud, MN
  • NPI 1902804149
  NPD (past)
• Melissa Anna Shaffer, O.D.

  • Optometrist
  • Saint Cloud, MN
  • NPI 1285833624
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1033118302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4118 W DIVISION ST",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563013706",
            "telephone_number": "320-252-2021",
            "fax_number": "320-252-7416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4118 W DIVISION ST",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563013706",
            "telephone_number": "320-252-2021",
            "fax_number": "320-252-7416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATJAC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KANE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "FRANCHISE OWNER",
        "authorized_official_telephone_number": "320-252-2021",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "383663100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HP",
            "identifier": "65377",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "110495",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "21-20963",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE",
            "identifier": "102081",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "65209PE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "65208PE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN PHY",
            "identifier": "C02754",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearle Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kavisha Patel
• Kishan Patel
• Yogesh Arvind Patel, M.D.
• David Patenaude
• Patjac Inc. (Pearle Vision)
• Patron Adult Day Services
• Patron Adult Foster Care
• Patron Companies
• Patron Home Health Companies
• Patron Supply Companies

• Eyewear Supplier in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.