Healthcare Provider Details

I. General information

NPI: 1588713010
Provider Name (Legal Business Name): JUSTIN MUSLAND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 ABERDEEN ST NE STE 2
BLAINE MN
55449-4753
US

IV. Provider business mailing address

14322 STAPLES ST NE
HAM LAKE MN
55304-4289
US

V. Phone/Fax

Practice location:
  • Phone: 651-746-9065
  • Fax:
Mailing address:
  • Phone: 651-746-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2978
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: