Jerome D. Poland, M.D., LTD

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

2807770002 Issued in MN

Legal business name

JEROME D. POLAND, M.D., LTD

Practice address

7636 Design Rd Ste 105
Baxter, MN 56425-8678

Phone

(218) 825-1976

Fax

(218) 828-9869

NPI assigned

Oct 24, 2007

Organization subpart

Yes

Parent organization

CROSBY EYE CLINICAs 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/Baxter Doing business as

Part of

Jerome D Poland MD LTD

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": "1295914463",
    "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": "7636 DESIGN RD STE 105",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258678",
            "telephone_number": "218-825-1976",
            "fax_number": "218-828-9869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME D. POLAND, M.D., LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSBY EYE CLINIC",
        "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": "2807770002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS DISPENSING",
            "identifier": "566R0CR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "CG9827",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261527400",
            "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/Baxter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Baxter, MN
• Providers in Baxter, 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 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.