Jerome D. Poland, M.D., LTD

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

2807770001 Issued in MN

Legal business name

JEROME D. POLAND, M.D., LTD

Practice address

43500 Migizi Dr
Onamia, MN 56359-2241

Phone

(320) 532-4163

Fax

(320) 532-4354

NPI assigned

Oct 24, 2007

Organization subpart

Yes

Parent organization

JEROME D. POLAND, M.D., LTDAs reported in NPPES

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

Authorized official

Name

Dr. Jerome D Poland, MD

Title

Medical Director

Phone

(218) 546-5108

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Crosby Eye Clinic Doing business as

Tax ID family

Jerome D Poland MD LTD2 organizations share this tax ID, including this one

Part of

Jerome D Poland MD LTD

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jerome D. Poland, M.D., LTD

  • Specialist
  • Onamia, MN
  • NPI 1366621534
  NPD tax ID

Locations

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1285813451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 3RD AVE NE",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411665",
            "telephone_number": "218-546-5108",
            "fax_number": "218-546-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43500 MIGIZI DR",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563592241",
            "telephone_number": "320-532-4163",
            "fax_number": "320-532-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME D. POLAND, M.D., LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEROME D. POLAND, M.D., LTD",
        "enumeration_date": "2007-10-24",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "POLAND",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "218-546-5108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": "2807770001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261527400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "CG9827",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS DISP",
            "identifier": "566R0CR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD MN",
            "identifier": "85038PO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crosby Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joan L Ice, R PH
• Ind School Dist 480 of Onamia
• Christina Marie Irrgang-Wade, MA, LPCC
• Roger Jahn, RN, PHN
• Jacquline Mae Jensen, RN
• Jerome D. Poland, M.D., LTD
• Twila Jesso, CNP
• Darcy Alan Johnson, RPH
• Pamela Ann Johnson, RPH
• Carol Alvina Kapinos, HHA

• All providers in Onamia, MN
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; 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.