1891784062 NPI number — NORTH LAND OPTICAL CO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891784062 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:
1891784062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2011
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:
10/19/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2100559 . This is a "MEDICA GLASSES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 74610NO . This is a "FIRST PLAN BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 794562100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110498 . This is a "UCARE MN GLASSES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2200240 . This is a "MEDICA VISION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP29194 . This is a "HEALTH PARTNERS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111276 . This is a "UCARE MN VISION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 61773 . This is a "HEALTH PARTNERS GLASSES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 74610NO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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