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General NPI Number Information
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NPI Number | 1942216353
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Entity Type | Individual
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Provider Name | RENAE LYNN RIES OD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 107 1ST STREET EAST
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City | CANBY
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State | MN
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Zip | 56220
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Country | US
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Telephone | 507-223-5818
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Fax | 507-223-7737
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Provider Business Mailing Address
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Address Line | 202 OCONNELL SUITE 1
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City | MARSHALL
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State | MN
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Zip | 56258
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Country | US
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Telephone | 507-532-5777
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Fax | 507-532-2087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2671
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License Number State | MN
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