Pine River Eye Center, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

PINE RIVER EYE CENTER, INC.

Practice address

5457 City Hall St
Nisswa, MN 56468-0349

Phone

(218) 963-2020

Fax

(218) 963-9811

NPI assigned

Mar 24, 2011

Organization subpart

Yes

Parent organization

PINE RIVER EYE CENTER, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael S. Marvin, O.D.

Title

Ceo

Phone

(218) 587-2020

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Associates In Eyecare Doing business as

Part of

Pine River Eye Center

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Pine River Eye Center, Inc.

  • Optometrist
  • Pine River, MN
  • NPI 1124035191
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1073812418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5457 CITY HALL ST.",
            "address_2": "PO BOX 349",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564680349",
            "telephone_number": "218-963-2020",
            "fax_number": "218-963-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5457 CITY HALL ST",
            "city": "NISSWA",
            "state": "MN",
            "postal_code": "564680349",
            "telephone_number": "218-963-2020",
            "fax_number": "218-963-9811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIVER EYE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINE RIVER EYE CENTER, INC.",
        "enumeration_date": "2011-03-24",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "MARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-587-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197023200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC PTAN",
            "identifier": "0579750001",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Associates In Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Partners in Conversation
• Paul Perpich, DDS
• Paul M Perpich, DDS
• Jessica Peterson, DDS
• Heather Noel Pierce
• John Charles Redebaugh, D.C.
• Mallori Ann Sheik, LICSW
• Susan M Slater, EDD- DR OF EDUCATION
• Lynn Marie Steidler-Thompson
• Valerie Stenger, COTA/L

• Eyewear Supplier in Nisswa, MN
• Providers in Nisswa, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.