Provider Demographics
NPI:1952579989
Name:DR. T.A. PINKE, INC
Entity Type:Organization
Organization Name:DR. T.A. PINKE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-375-3737
Mailing Address - Street 1:517 1ST AVE S
Mailing Address - Street 2:P.O. BOX 110
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-1727
Mailing Address - Country:US
Mailing Address - Phone:507-375-3737
Mailing Address - Fax:
Practice Address - Street 1:517 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1727
Practice Address - Country:US
Practice Address - Phone:507-375-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN419000340Medicaid
MN419000340Medicaid
MN0301500001Medicare NSC
MN419000340Medicare PIN