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Contact Information

PINE RIVER EYE CENTER, INC.
5457 CITY HALL ST
NISSWA, MN56468-0349
 Phone: 218-963-2020
 Fax: 218-963-9811
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for PINE RIVER EYE CENTER, INC.

NPI Number 1073812418
LBN Legal business name PINE RIVER EYE CENTER, INC.
Authorized official MICHAEL MARVIN - (CEO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 03/24/2011
Last updated 03/24/2011 - About 15 years ago
Identifiers
MN Medicaid 197023200
MN Other 0579750001 DMERC PTAN
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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