Pine Eye Associates, PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PINE EYE ASSOCIATES, PA

Practice address

110 Evergreen Square
Pine City, MN 55063

Phone

(320) 629-7262

Fax

(320) 629-7789

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Kristi A Iverson, OD

Title

Cfo, Owner

Phone

(320) 629-7262

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine Eye Associates Doing business as

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1851324313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 EVERGREEN SQUARE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "55063",
            "telephone_number": "320-629-7262",
            "fax_number": "320-629-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EVERGREEN SQUARE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "55063",
            "telephone_number": "320-629-7262",
            "fax_number": "320-629-7789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE EYE ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "IVERSON",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO, OWNER",
        "authorized_official_telephone_number": "320-629-7262",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "644731700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Eye Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marilyn Jean Pedersen, LADC
• Hiedi Philstrom
• Pine City Area Clinic
• Pine City Chiropractic PLLC
• Pine City Family Dental
• Michaela Janssen Pohl, MA, LPCC
• Jeffrey Pounds, LP
• Power Chairs and Scooter Store Medical Supply LLC
• Premier Chiropractic LLC
• Umair Rehman, MD

• Optometrist in Pine City, MN
• Providers in Pine City, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; 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.