Organization
BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNE C ANDERSON (MANAGER)
(218) 834-8070
Entity
Organization
Contact information
Practice address
802 11TH ST, STE A, TWO HARBORS, MN 55616-1413
(218) 834-8070
Mailing address
802 11TH ST STE A, TWO HARBORS, MN 55616-1413
(218) 834-8070
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122437
U CARE
MN
01
—
2122765
MEDICA
MN
01
—
5506010002
DMERC
MN
01
—
74123BL
BCBS OF MN
MN
Enumeration date
12/07/2006
Last updated
08/22/2020
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