Provider Demographics
NPI:1700024437
Name:JAY MAR OPTICIANS, INC
Entity Type:Organization
Organization Name:JAY MAR OPTICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BJOSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-920-8290
Mailing Address - Street 1:6545 FRANCE AVE SO.
Mailing Address - Street 2:SUITE 605
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2117
Mailing Address - Country:US
Mailing Address - Phone:952-920-8290
Mailing Address - Fax:952-920-3089
Practice Address - Street 1:6545 FRANCE AVE SO
Practice Address - Street 2:SUITE 605
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2117
Practice Address - Country:US
Practice Address - Phone:952-920-8290
Practice Address - Fax:952-920-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0341530001Medicare UPIN