Provider Demographics
NPI:1205951480
Name:TOKARCZYK ENTERPRISES
Entity type:Organization
Organization Name:TOKARCZYK ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKARCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-1519
Mailing Address - Street 1:229 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1401
Mailing Address - Country:US
Mailing Address - Phone:712-252-1519
Mailing Address - Fax:712-252-1916
Practice Address - Street 1:621 3RD AVE
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2637
Practice Address - Country:US
Practice Address - Phone:218-283-2015
Practice Address - Fax:218-283-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2453963332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2100341Medicaid
08D16IDOtherBCBS
22318OtherSPECTRA
MN2100341Medicaid