Provider Demographics
NPI:1508951765
Name:RIVER VALLEY EYE ASSOCIATES INC.
Entity Type:Organization
Organization Name:RIVER VALLEY EYE ASSOCIATES INC.
Other - Org Name:RIVER VALLEY EYE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-645-9202
Mailing Address - Street 1:2019 JEFFERSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3258
Mailing Address - Country:US
Mailing Address - Phone:507-645-2020
Mailing Address - Fax:507-645-9203
Practice Address - Street 1:2019 JEFFERSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3258
Practice Address - Country:US
Practice Address - Phone:507-645-2020
Practice Address - Fax:507-645-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN313638800Medicaid
MN367R8NOOtherBLUE CROSS BLUE SHIELD
MN21-00444OtherMEDICA
MN21-00444OtherMEDICA