Organization
DERIN J VAN LOON OD PA
Active
Other names
Blustin Optical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERIN JOHN VAN LOON OD (OWNER OPTOMETRIST)
(218) 727-1004
Entity
Organization
Contact information
Practice address
213 W 1ST ST, DULUTH, MN 55802-1985
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413668300
—
MN
01
—
DD9233
RAILROAD MEDICARE
MN
Enumeration date
01/09/2006
Last updated
07/07/2008
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