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General NPI Number Information
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NPI Number | 1033118302
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Entity Type | Organization
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Legal Business Name | PATJAC, INC.
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4118 W DIVISION ST
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City | SAINT CLOUD
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State | MN
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Zip | 56301-3706
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Country | US
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Telephone | 320-252-2021
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Fax | 320-252-7416
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Provider Business Mailing Address
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Address Line | 4118 W DIVISION ST
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City | SAINT CLOUD
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State | MN
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Zip | 56301-3706
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Country | US
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Telephone | 320-252-2021
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Fax | 320-252-7416
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Authorized Official
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Title or Position | FRANCHISE OWNER
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Name | MR. PATRICK O KANE
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Credential | OPTICIAN
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Telephone | 320-252-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | MN
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