Active NPI
Michael S Marvin, O.D.
- Optometrist
- Pine River, MN
National Provider Identifier
1396710125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1895
- Practice address
- 424 Barclay Ave
Pine River, MN 56474-0457 - Phone
- (218) 587-2020
- Fax
- (218) 587-3229
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1895 | MN | Primary |
Addresses
Primary practice location
424 Barclay Ave
Pine River, MN 56474-0457
Mailing address
424 Barclay Ave
P O Box 457
Pine River, MN 56474-0457
Phone (218) 587-2020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1895 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396710125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "424 BARCLAY AVE",
"address_2": "P O BOX 457",
"city": "PINE RIVER",
"state": "MN",
"postal_code": "564740457",
"telephone_number": "218-587-2020",
"fax_number": "218-587-3229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "424 BARCLAY AVE",
"city": "PINE RIVER",
"state": "MN",
"postal_code": "564740457",
"telephone_number": "218-587-2020",
"fax_number": "218-587-3229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARVIN",
"first_name": "MICHAEL",
"middle_name": "S",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1895",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.