Provider Demographics
NPI:1124135736
Name:LINVILLE, JANE E (OD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:LINVILLE
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 1:112B MAIN ST S
Mailing Address - Street 2:PO BOX 202
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-4400
Mailing Address - Country:US
Mailing Address - Phone:320-468-2020
Mailing Address - Fax:320-468-1111
Practice Address - Street 1:112B MAIN ST S
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-4400
Practice Address - Country:US
Practice Address - Phone:320-468-2020
Practice Address - Fax:320-468-1111
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U25846Medicare UPIN