Pine River Eye Center, Inc.

NPI #1508165572 in Baxter, Minnesota

Provider Information

NPI Number: 1508165572
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 16, 2011
Last Updated: Mar 16, 2011

Practice Location

Address: 14453 EDGEWOOD DR
City: Baxter
State: Minnesota
ZIP Code: 56425-8459
Phone: (218) 829-1789

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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