Provider Demographics
NPI:1659427672
Name:PBR OPTOMETRISTS LTD
Entity Type:Organization
Organization Name:PBR OPTOMETRISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PABST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-637-5715
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-0479
Mailing Address - Country:US
Mailing Address - Phone:507-637-5715
Mailing Address - Fax:507-637-5715
Practice Address - Street 1:500 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1168
Practice Address - Country:US
Practice Address - Phone:507-637-5715
Practice Address - Fax:507-637-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN47652PBOtherBLUECROSS BLUESHIELD
MN990021013139OtherPREFERREDONE
MN0292480001Medicare NSC
MN47652PBOtherBLUECROSS BLUESHIELD