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General NPI Number Information
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NPI Number | 1912847500
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Entity Type | Organization
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Legal Business Name | PINE RIVER GROUP LLC
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 500 BROAD ST STE 3
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-4924
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Country | US
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Telephone | 610-831-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 9867 FLORENCE PL
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-3561
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JOHN HEIDENREICH
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Credential |
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Telephone | 720-252-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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