BLAINE EYE CLINIC OPTOMETRISTS, P.A. (NPI# 1043363401) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043363401 |
| Entity Type | Organization |
| Organization Name | BLAINE EYE CLINIC OPTOMETRISTS, P.A. |
| Other Organization Name | BLAINE EYE CLINIC |
| Practice Address |
12170 Aberdeen St Ne Blaine MN 55449-4716 |
| Practice Telephone | 7637577000 |
| Practice Fax Number | 7637573328 |
| Mailing Telephone | 7637577000 |
| Mailing Fax Number | 7637573328 |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2011-02-15 |
| Authorized Official Name | LYNN ALAN SULERUD (OWNER) |
| Authorized Official Telephone | 7637577000 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | MN | Eye and Vision Services Providers | |
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | RAILROAD MEDICARE | DB3402 | 01 |
| MN | 221526800 | 05 |
| Other Name | Type Code |
|---|---|
| Blaine Eye Clinic | Doing Business As Name - Organization |
| Street Address |
12170 ABERDEEN ST NE |
| City | BLAINE |
| State | MN |
| Zip Code | 55449-4716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417462698 | Ashley Ann Berens | Optometrist | 12170 Aberdeen St Ne, Blaine, MN 55449 | 2017-12-09 |
| 1033403464 | Northland Hearing Center Inc | Audiologist-Hearing Aid Fitter | 12170 Aberdeen St Ne, Blaine, MN 55449-4716 | 2011-06-02 |
| 1013242197 | Megan Marie Sis | Optometrist | 12170 Aberdeen St Ne, Blaine, MN 55449-4716 | 2009-10-07 |
| 1265694715 | Breann Marie Forliti | Optometrist | 12170 Aberdeen St Ne, Blaine, MN 55449-4716 | 2008-06-26 |
| 1548469737 | Rosamond Hannah Tedesco | Optometrist | 12170 Aberdeen St Ne, Blaine, MN 55449 | 2007-07-17 |
| 1013060409 | Lynn Alan Sulerud | Optometrist | 12170 Aberdeen St Ne, Blaine, MN 55449-4716 | 2007-01-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033736368 | Landon Thomas Case | Dentist | 10729 Town Square Drive Ne, Ste 100, Blaine, MN 55449 | 2020-07-02 |
| 1881168441 | Ear Institutes, LLC | Otolaryngology | 4365 Pleasant Ridge Dr Ne, Suite 106, Blaine, MN 55449 | 2019-01-17 |
| 1841776242 | Kristin Broback | Nurse Practitioner | 10705 Town Square Dr Ne #100, Blaine, MN 55449 | 2018-07-18 |
| 1043719016 | Robin Lynn Broen | Registered Nurse | 3012 129th Ave Ne, Blaine, MN 55449 | 2018-02-06 |
| 1194197368 | Lund Health Professional Corporation | Chiropractor | 1360 101st Ave Ne, Suite 140, Blaine, MN 55449 | 2015-10-27 |
| 1871989806 | Blaine Wp II, LLC | Assisted Living Facility | 12402 Jamestown Street Ne, Blaine, MN 55449 | 2015-04-07 |
| 1154761633 | Jean Budge | Marriage & Family Therapist | 11800 Aberdeen Street Ne, Suite 100, Blaine, MN 55449 | 2013-06-28 |
| 1295013498 | Jeff K Yu | Veterinarian | 11850 Aberdeen St Ne, Blaine, MN 55449 | 2011-07-22 |
| 1528394707 | Julie Ann Eibensteiner | Physical Therapist | 11304 Davenport Circle Ne #a, Minneapolis, MN 55449 | 2009-10-23 |
| 1871725333 | Deborah Kathryn Zongo | Nurse Practitioner | 10190 Baltimore St Ne Ste 100, Blaine, MN 55449 | 2009-08-18 |
| Find all providers in zip 55449 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235681958 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 10881 University Ave Ne, Blaine, MN 55434 | 2016-10-28 |
| 1205273984 | Walmart Inc. | Durable Medical Equipment & Medical Supplies | 11505 Ulysses St Ne, Blaine, MN 55434-4239 | 2013-06-04 |
| 1952603862 | Wellness Diabetes Care LLC | Durable Medical Equipment & Medical Supplies | 11005 Tyler St Ne, Blaine, MN 55434-4535 | 2010-11-29 |
| 1255574430 | Superior Medical Services Inc | Durable Medical Equipment & Medical Supplies | 10995 Club West Pkwy, Suite 500, Blaine, MN 55449-5058 | 2009-04-17 |
| 1750566287 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 10905 Ulysses St Ne, Blaine, MN 55434-3827 | 2008-01-03 |
| 1093824302 | Thrifty Payless Inc | Durable Medical Equipment & Medical Supplies | 1195 Boblett Street, Blaine, WA 98230-5157 | 2006-08-30 |
| 1043326457 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 12595 Central Ave Ne, Blaine, MN 55434 | 2006-08-21 |
| 1225143365 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 585 Northtown Dr Ne, Blaine, MN 55434 | 2006-08-20 |
| 1649385782 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 4205 Pheasant Ridge Dr Ne, Blaine, MN 55449-4529 | 2006-08-20 |
| 1124033352 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 600 County Road 10 Ne, Blaine, MN 55434-2329 | 2006-07-29 |
| Find all providers in BLAINE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.