Pine River Eye Center, Inc.

NPI #1073812418 in Nisswa, Minnesota

Provider Information

NPI Number: 1073812418
Entity Type: Organization
Organization Name: Pine River Eye Center, Inc.
Subpart: Yes (part of a larger organization)
Parent Organization: PINE RIVER EYE CENTER, INC.
Primary Specialty: Eyewear Supplier
Enumeration Date: Mar 24, 2011
Last Updated: Mar 24, 2011

Practice Location

Address: 5457 CITY HALL ST
City: Nisswa
State: Minnesota
ZIP Code: 56468-0349
Phone: (218) 963-2020

Authorized Official

Name: DR. MICHAEL S. MARVIN, O.D.
Title: CEO
Phone: (218) 587-2020

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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