Provider Demographics
NPI:1922197714
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
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-223-5818
Mailing Address - Street 1:130 1ST ST W STE 105
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:MN
Mailing Address - Zip Code:56220-1465
Mailing Address - Country:US
Mailing Address - Phone:507-223-5818
Mailing Address - Fax:507-223-7737
Practice Address - Street 1:130 1ST ST W STE 105
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220-1465
Practice Address - Country:US
Practice Address - Phone:507-223-5818
Practice Address - Fax:507-223-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2670152W00000X
MN2671152W00000X
MN3204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN044742100Medicaid
114766OtherUCARE
MN163J3HEOtherBLUE PLUS
MN163J2HEOtherBCBS OF MN
97203OtherHEALTH PARTNERS
DA3363OtherRAILROAD MEDICARE
=========OtherMEDICA
MN163J3HEOtherBLUE PLUS
MN044742100Medicaid
97203OtherHEALTH PARTNERS
MN163J3HEOtherBLUE PLUS