Derin J Van Loon OD PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

DERIN J VAN LOON OD PA

Doing business as

Blustin Optical Center

Practice address

213 W 1St St
Duluth, MN 55802-1985

Phone

(218) 727-1004

Fax

(218) 727-1525

NPI assigned

Jan 9, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Derin John Van Loon, ODNPI 1568440675

Title

Owner Optometrist

Phone

(218) 727-1004

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Blustin Optical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 4

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
  Medicare reassignment Authorized official
• Derek Michaelis

  • Optometrist
  • Duluth, MN
  • NPI 1932764883
  Medicare reassignment NPD
• Christopher Allen McDowell, O.D.

  • Optometrist
  • Cloquet, MN
  • NPI 1235188079
  NPD (past)
• Kimberly Helen Watson, OD

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

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1811975931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 W 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021985",
            "telephone_number": "218-727-1004",
            "fax_number": "218-727-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 W 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021985",
            "telephone_number": "218-727-1004",
            "fax_number": "218-727-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERIN J VAN LOON OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "VAN LOON",
        "authorized_official_first_name": "DERIN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER OPTOMETRIST",
        "authorized_official_telephone_number": "218-727-1004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DD9233",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413668300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blustin Optical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dental Specialist of Minnesota, PLLC (The Dental Specialist Downtown Duluth)
• Brittany L Denucci
• Christopher David Denzler
• Christine Charlotte Depenthal
• Bruce James Derauf
• Dermatology Duluth LLC
• Dale Edward Derocher, MS
• Kristy Lynn Derosia, R.D.H
• Cathy Jo Derosier, RN
• Constance Jeanne Derungs

• Optometrist in Duluth, MN
• Providers in Duluth, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.