Pine River Eye Center, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

PINE RIVER EYE CENTER, INC.

Practice address

14453 Edgewood Dr
Baxter, MN 56425-8459

Phone

(218) 829-1789

Fax

(218) 829-1780

NPI assigned

Mar 16, 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

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

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": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300233600000",
    "number": "1508165572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14453 EDGEWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258459",
            "telephone_number": "218-829-1789",
            "fax_number": "218-829-1780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14453 EDGEWOOD DR",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258459",
            "telephone_number": "218-829-1789",
            "fax_number": "218-829-1780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIVER EYE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINE RIVER EYE CENTER, INC.",
        "enumeration_date": "2011-03-16",
        "last_updated": "2011-03-16",
        "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"
        }
    ]
}

• Jolene Beth Peterson
• Sandra Rae Peterson
• Teri Kaminski Peterson
• Ava Pikula
• Pine Lakes Endodontics PA
• Laura Helen Platt
• Cory Pliscott
• David Edward Plowman
• Pohl Childrens Scholarship Foundation LLC
• Emily Pooler

• Eyewear Supplier in Baxter, MN
• Providers in Baxter, 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 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.