Provider Demographics
NPI:1124034475
Name:JORZACH INC
Entity Type:Organization
Organization Name:JORZACH INC
Other - Org Name:HEARTLAND EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OD
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-532-5777
Mailing Address - Street 1:202 OCONNELL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258
Mailing Address - Country:US
Mailing Address - Phone:507-532-5777
Mailing Address - Fax:507-532-2087
Practice Address - Street 1:202 OCONNELL ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-532-5777
Practice Address - Fax:507-532-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2670152W00000X
MN2671152W00000X
MN3204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN044722600Medicaid
MN164J3HEOtherBCBS OF MN
MN164J6HEOtherBCBS BLUE PLUS OF MN
97208OtherHEALTH PARTNERS
MN152763OtherUCARE
MN=========OtherMEDICA
MN164J3HEOtherBCBS OF MN
SD=========Medicaid
MN=========OtherPREFERRED ONE
MN=========OtherTRICARE
MN044722600Medicaid
97208OtherHEALTH PARTNERS
MNDA3362Medicare PIN
SD=========Medicaid