Provider Demographics
NPI:1588713010
Name:MUSLAND, JUSTIN (OD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MUSLAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14322 STAPLES ST NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE X
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4289
Mailing Address - Country:US
Mailing Address - Phone:651-746-9065
Mailing Address - Fax:
Practice Address - Street 1:143 WILLOW BND
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3934
Practice Address - Country:US
Practice Address - Phone:612-537-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNVO3843Medicare UPIN