Provider Demographics
NPI:1821442252
Name:RIVER COUNTRY EYE CARE, PLLC
Entity Type:Organization
Organization Name:RIVER COUNTRY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/AUTHORIZED MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:269-244-3350
Mailing Address - Street 1:1107 W BROADWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8376
Mailing Address - Country:US
Mailing Address - Phone:269-244-3350
Mailing Address - Fax:269-244-3351
Practice Address - Street 1:1107 W BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8376
Practice Address - Country:US
Practice Address - Phone:269-244-3350
Practice Address - Fax:269-244-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty