Blustin Optical Center Dba Derin J Van Loon, O.D.

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D.

Practice address

802 11TH St
Ste a
Two Harbors, MN 55616-1413

Phone

(218) 834-8070

NPI assigned

Dec 7, 2006

Organization subpart

No

Name

Mrs. Anne C Anderson

Title

Manager

Phone

(218) 834-8070

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derin John Van Loon, OD

  • Optometrist
  • Duluth, MN
  • NPI 1568440675
  NPD
• Kimberly Helen Watson, OD

  • Optometrist
  • Duluth, MN
  • NPI 1295713303
  NPD (past)

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629137419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 11TH ST STE A",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161413",
            "telephone_number": "218-834-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 11TH ST",
            "address_2": "STE A",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161413",
            "telephone_number": "218-834-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "218-834-8070",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "122437",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "74123BL",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "5506010002",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2122765",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Francis Anderson, RDH
• Barross Manor, LLC
• Stephanie Bellrichard, PHARMD
• Jason Olai Berg, DDS
• Jacob Thomas Blong
• Bodies in Balance of Two Harbors, Inc.
• Nicole Bogenreif, PT, DPT
• Jody Lynn Boyer, OTR/L
• Brightwater Health Dba Human Development Center
• Lisa D Bucklew, PHARMACY TECHNICIAN

• All providers in Two Harbors, MN
• Optician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.