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General NPI Number Information
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NPI Number | 1609062272
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Entity Type | Organization
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Legal Business Name | MICHAEL REXINE OD PC
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 32 MAIN ST W
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City | MAYVILLE
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State | ND
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Zip | 58257-1314
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Country | US
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Telephone | 701-786-2666
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Fax | 701-786-2292
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Provider Business Mailing Address
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Address Line | 32 MAIN ST W
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City | MAYVILLE
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State | ND
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Zip | 58257-1314
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Country | US
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Telephone | 701-786-2666
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Fax | 701-786-2292
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL KENNETH REXINE
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Credential | OD
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Telephone | 701-786-2666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 575
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License Number State | ND
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