Individual
DERIN JOHN VAN LOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
213 W 1ST ST, DULUTH, MN 55802-1909
(218) 727-1004
(218) 727-1525
Mailing address
213 W 1ST ST, DULUTH, MN 55802-1985
(218) 727-1004
(218) 727-1525
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2650
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
637896000
—
MN
Enumeration date
01/09/2006
Last updated
06/19/2018
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