| Organization Name: | BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D. |
| NPI Number: | 1629137419 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANNE C ANDERSON (MANAGER) |
| Mailing Address: | 802 11th St Ste A Two Harbors |
| State: | MN US |
| Postal Code: | 556161413 |
| Phone Number: | 2188348070 |
| Fax Number: | |
| NPI Enumeration Date: | 12/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |