PINE RIVER EYE CENTER, INC. (NPI# 1073812418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073812418 |
| Entity Type | Organization |
| Organization Name | PINE RIVER EYE CENTER, INC. |
| Other Organization Name | ASSOCIATES IN EYECARE |
| Practice Address |
5457 City Hall St Nisswa MN 56468-0349 |
| Mailing Address |
5457 City Hall St. Po Box 349 Nisswa MN 56468-0349 |
| Practice Telephone | 2189632020 |
| Practice Fax Number | 2189639811 |
| Mailing Telephone | 2189632020 |
| Mailing Fax Number | 2189639811 |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2011-03-24 |
| Authorized Official Name | DR. MICHAEL S. MARVIN (CEO) |
| Authorized Official Telephone | 2185872020 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | PINE RIVER EYE CENTER, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | DMERC PTAN | 0579750001 | 01 |
| MN | 197023200 | 05 |
| Other Name | Type Code |
|---|---|
| Associates In Eyecare | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124035191 | Pine River Eye Center, Inc. | Optometrist | 424 Barclay Ave., Pine River, MN 56474-0457 | 2006-08-02 |
| 1508165572 | Pine River Eye Center, Inc. | Eyewear Supplier (Equipment, not the service) | 14453 Edgewood Dr, Baxter, MN 56425-8459 | 2011-03-16 |
| Street Address |
5457 CITY HALL ST |
| City | NISSWA |
| State | MN |
| Zip Code | 56468-0349 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679792147 | Paul M Perpich | Dentist | 5461 City Hall, Nisswa, MN 56468 | 2007-04-24 |
| 1972649846 | Mary Katherine Verkennes | Psychologist | 25039 East Clark Lake Road, Nisswa, MN 56468 | 2007-01-29 |
| 1578646360 | Wellnessone of Nisswa | Chiropractor | 5482 County Rd. 18, Nisswa, MN 56468 | 2006-10-23 |
| 1043393838 | Derrek Johnson | Chiropractor | 5482 County Road 18, Nisswa, MN 56468 | 2006-10-23 |
| 1295816486 | Seth Michael Smart | Chiropractor | 5314 Nisswa Avenue, Nisswa, MN 56468 | 2006-10-17 |
| 1588764856 | Craig Brian Johnson | Dentist | 25579 Church St, Nisswa, MN 56468 | 2006-09-25 |
| 1811487887 | Acquire Mental Health Clinic | Counselor | 25282 Hazelwood Dr, Nisswa, MN 56468 | 2018-05-15 |
| 1114250313 | Aron Michael Stumvoll | Chiropractor | 5482 County Road 18, Nisswa, MN 56468 | 2009-09-08 |
| 1740293083 | The Evangelical Lutheran Good Samaritan Society | Hospice Care, Community Based | 24090 Smiley Rd Ste 200, Nisswa, MN 56468 | 2006-08-15 |
| 1801019799 | Dennis Dean Hins | Pharmacist | 25527 Main Street, Nisswa, MN 56468-0200 | 2007-04-10 |
| Find all providers in zip 56468 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493903 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 11995 Business Park Blvd N, Champlin, MN 55316 | 2020-10-02 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1891351268 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1101 E College Dr, Marshall, MN 56258-2366 | 2019-05-11 |
| 1730745100 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1459 W Service Dr, Winona, MN 55987-2512 | 2019-05-11 |
| 1649836016 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1023 E Blue Earth Ave, Fairmont, MN 56031-4076 | 2019-05-11 |
| 1124684592 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1004 18th Ave Nw Ste D, Austin, MN 55912-1993 | 2019-05-11 |
| 1053977421 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1620 Broadway Ave S Ste 4, Rochester, MN 55904-7927 | 2019-05-11 |
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1831651165 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 3366 Oakdale Ave N Ste 140, Robbinsdale, MN 55422-2961 | 2019-04-04 |
| 1538624341 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 9825 Hospital Dr # 106, Maple Grove, MN 55369-4479 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.