Provider Demographics
NPI:1942216353
Name:RIES, RENAE LYNN (OD)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:LYNN
Last Name:RIES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OCONNELL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258
Mailing Address - Country:US
Mailing Address - Phone:507-532-5777
Mailing Address - Fax:507-532-2087
Practice Address - Street 1:107 1ST STREET EAST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220
Practice Address - Country:US
Practice Address - Phone:507-223-5818
Practice Address - Fax:507-223-7737
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN164J1RIOtherBLUE CROSS BLUE SHIELD
MN774451025289OtherPREFERRED ONE
MN164J1RIOtherBCBS BLUE PLUS OF MN
MN781101025289OtherPREFERRED ONE
MN164J2RIOtherBCBS OF MN
MN164J5RIOtherBCBS BLUE PLUS OF MN
MN2200504OtherMEDICA
MN77451025290OtherPREFERRED ONE
MN91902440Medicaid
MN123166OtherUCARE MN
MN164J5RIOtherBCBS OF MN
SD9203177OtherSOUTH DAKOTA MEDICAID
MN164J2RIOtherBCBS BLUE PLUS OF MN
MN2200506OtherMEDICA
MN2200505OtherMEDICA
MN2200506OtherMEDICA