Organization
BLAINE EYE CLINIC OPTOMETRISTS, P.A.
Active
Other names
Blaine Eye Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN ALAN SULERUD O.D. (OWNER)
(763) 757-7000
Entity
Organization
Contact information
Practice address
12170 ABERDEEN ST NE, BLAINE, MN 55449-4716
(763) 757-7000
(763) 757-3328
Mailing address
12170 ABERDEEN ST NE, BLAINE, MN 55449-4716
(763) 757-7000
(763) 757-3328
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
MN
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221526800
—
MN
01
—
DB3402
RAILROAD MEDICARE
MN
Enumeration date
01/19/2007
Last updated
02/15/2011
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