Avera Marshall
Organization Active NPI Optometrist · Marshall, MN
NPI 1760740567 · NPPES record last updated Dec 2, 2022
Key facts
- NPI
- 1760740567
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- AVERA MARSHALL
- Practice address
- 121 N 3Rd St
Marshall, MN 56258-1324 - Phone
- (507) 532-5143
- NPI assigned
- Apr 30, 2012
- Organization subpart
- No
Authorized official
- Name
- Debbie Streier
- Title
- Ceo
- Phone
- (507) 537-9160
Other NPIs on the same Medicare enrollment 18
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
Locations
121 N 3rd St
Marshall, MN 56258
Phone (507) 532-5143
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
121 N 3Rd St
Marshall, MN 56258-1324
Mailing address
300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 532-9661
Other names
- Avera Medical Group Optometry Marshall
Other providers in Marshall, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 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.