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NPI Code Detail

MEDICARE: BLAINE EYE CLINIC OPTOMETRISTS, P.A.

MEDICARE: BLAINE EYE CLINIC OPTOMETRISTS, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristMN
2332B00000XDurable Medical Equipment & Medical SuppliesMN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DB3402OTHERMNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043363401
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLAINE EYE CLINIC OPTOMETRISTS, P.A.
Provider Business Mailing Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 763-757-7000
Fax Number : 763-757-3328
Provider Business Practice Location Address
First Line : 12170 ABERDEEN ST NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-4716
Country : US
Telephone Number : 763-757-7000
Fax Number : 763-757-3328
Authorized Official
Title or Position : OWNER
Name : LYNN ALAN SULERUD
Credential : O.D.
Telephone Number : 763-757-7000
Provider Enumeration Date : 01/19/2007
Last Update Date : 02/15/2011

Similar Medicare Providers

1013060409 — LYNN ALAN SULERUD O.D.
Practice Location Address:
12170 ABERDEEN ST NE
BLAINE, MN
55449-4716
Practice Phone: 763-757-7000
Practice Fax: 763-757-3328
1265694715 — MRS. BREANN MARIE FORLITI O.D.
Practice Location Address:
12170 ABERDEEN ST NE
BLAINE, MN
55449-4716
Practice Phone: 763-757-7000
Practice Fax: 763-757-3328
1013242197 — MEGAN MARIE SIS OD, MS, FAAO
Practice Location Address:
12170 ABERDEEN ST NE
BLAINE, MN
55449-4716
Practice Phone: 763-757-7000
Practice Fax: 763-757-3328
1033403464 — NORTHLAND HEARING CENTER INC
Practice Location Address:
12170 ABERDEEN ST NE
BLAINE, MN
55449-4716
Practice Phone: 763-795-6047
Practice Fax:
1285206318 — LANDON MICHAEL KUDRNA O.D.
Practice Location Address:
12170 ABERDEEN ST NE
BLAINE, MN
55449-4716
Practice Phone: 637-577-0007
Practice Fax: 763-757-3328
1134272586 — GEORGIANN KAE JENSEN O.D.
Practice Location Address:
12170 ABERDEEN ST NE
MINNEAPOLIS, MN
55449-4716
Practice Phone: 763-757-7000
Practice Fax: 763-757-3328

Directions to “BLAINE EYE CLINIC OPTOMETRISTS, P.A. ” Practice Location

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