Avera Marshall
Organization Active NPI Optometrist · Windom, MN
NPI 1083925366 · NPPES record last updated Dec 1, 2022
Key facts
- NPI
- 1083925366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- AVERA MARSHALL
- Practice address
- 1006 4TH Ave
Windom, MN 56101-1440 - Phone
- (507) 831-2429
- NPI assigned
- Jul 1, 2010
- Organization subpart
- No
Authorized official
- Name
- Debbie Streier
- Title
- Ceo
- Phone
- (507) 537-9160
Other NPIs on the same Medicare enrollment 18
Member of 1
Practitioners 2
-
Jefferson Reynolds, DNAP, CRNA
-
Michael D Gillett, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000219 | MN | Part B Supplier - Clinic/Group Practice | 5799695227 |
Receives reassigned benefits from 278 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tracy, MN; Springfield, MN; Dawson, MN; Redwood Falls, MN; Minneota, MN; Marshall, MN; Eden Prairie, MN; Canby, MN… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | MN | Yes | |
| Ophthalmology Physician |
207W00000X | MN | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
1006 4TH Ave
Windom, MN 56101-1440
Mailing address
1006 4TH Ave
Windom, MN 56101-1440
Phone (507) 831-2429
Other names
- Avera Medical Group Optometry Windom
Other providers in Windom, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.