Provider Demographics
NPI:1942395702
Name:JORZACH INC
Entity type:Organization
Organization Name:JORZACH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:WILLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-769-2977
Mailing Address - Street 1:878 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232
Mailing Address - Country:US
Mailing Address - Phone:320-769-2977
Mailing Address - Fax:320-769-4322
Practice Address - Street 1:878 6TH ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232
Practice Address - Country:US
Practice Address - Phone:320-769-2977
Practice Address - Fax:320-769-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2671152W00000X
MN2670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN044714500Medicaid
MN163J8HEOtherBLUE PLUS
97204OtherHEALTH PARTNERS
MN163J7HEOtherBLUE CROSS BLUE SHIELD
126236OtherUCARE
MN114766OtherUCARE MN
MN163J8HEOtherBLUE PLUS
=========OtherMEDICA
=========OtherPREFERRED ONE
126236OtherUCARE
97204OtherHEALTH PARTNERS
=========OtherMEDICA