Provider Demographics
NPI:1477961019
Name:S SJOBERG PLC
Entity Type:Organization
Organization Name:S SJOBERG PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SJOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:218-546-5108
Mailing Address - Street 1:1 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1665
Mailing Address - Country:US
Mailing Address - Phone:218-546-5108
Mailing Address - Fax:218-546-5736
Practice Address - Street 1:7636 DESIGN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8677
Practice Address - Country:US
Practice Address - Phone:218-825-1976
Practice Address - Fax:218-828-9869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S SJOBERG PCL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-28
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7266550002Medicare NSC