1699916544 NPI number — NORTH LAND OPTICAL CO

Table of content: (NPI 1699916544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699916544 NPI number — NORTH LAND OPTICAL CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH LAND OPTICAL CO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699916544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 E SUPERIOR ST
Provider Second Line Business Mailing Address:
STE # 111
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55802-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-722-4212
Provider Business Mailing Address Fax Number:
218-722-4212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 E SUPERIOR ST
Provider Second Line Business Practice Location Address:
STE # 111
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55802-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-722-4212
Provider Business Practice Location Address Fax Number:
218-722-4212
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HORN
Authorized Official First Name:
RON
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
218-722-4212

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110498 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1891784062 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111276 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 21-00559 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1891784062 . This is a "BLUE CROSS BLUE SHEILD OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1891784062 . This is a "BLUE PLUS OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22-00240 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 61773 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1891784062 . This is a "FIRST PLAN BLUE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com