Active NPI
Lynn Alan Sulerud, O.D.
- Optometrist
- Blaine, MN
National Provider Identifier
1013060409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1698
- Practice address
- 12170 Aberdeen St NE
Blaine, MN 55449-4716 - Phone
- (763) 757-7000
- Fax
- (763) 757-3328
- NPI assigned
- Jan 19, 2007
- Last updated
- Sep 27, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1698 | MN | Primary |
Addresses
Primary practice location
12170 Aberdeen St NE
Blaine, MN 55449-4716
Mailing address
12170 Aberdeen St NE
Blaine, MN 55449-4716
Phone (763) 757-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1698 | MN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285545600000",
"number": "1013060409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12170 ABERDEEN ST NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554494716",
"telephone_number": "763-757-7000",
"fax_number": "763-757-3328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12170 ABERDEEN ST NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554494716",
"telephone_number": "763-757-7000",
"fax_number": "763-757-3328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULERUD",
"first_name": "LYNN",
"middle_name": "ALAN",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2010-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.