Organization
PINE RIVER EYE CENTER, INC.
Active
Parent organization
PINE RIVER EYE CENTER, INC.
Other names
Associates In Eyecare
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE RIVER EYE CENTER, INC.
Authorized official
DR. MICHAEL S. MARVIN O.D. (CEO)
(218) 587-2020
Entity
Organization
Contact information
Practice address
14453 EDGEWOOD DR, BAXTER, MN 56425-8459
(218) 829-1789
(218) 829-1780
Mailing address
14453 EDGEWOOD DR, BAXTER, MN 56425-8459
(218) 829-1789
(218) 829-1780
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0579750001
DMERC PTAN
MN
05
—
197023200
—
MN
Enumeration date
03/16/2011
Last updated
03/16/2011
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