Provider Demographics
NPI:1699916544
Name:NORTH LAND OPTICAL CO
Entity type:Organization
Organization Name:NORTH LAND OPTICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:218-722-4212
Mailing Address - Street 1:600 E SUPERIOR ST
Mailing Address - Street 2:STE # 111
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2222
Mailing Address - Country:US
Mailing Address - Phone:218-722-4212
Mailing Address - Fax:218-722-4212
Practice Address - Street 1:600 E SUPERIOR ST
Practice Address - Street 2:STE # 111
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2222
Practice Address - Country:US
Practice Address - Phone:218-722-4212
Practice Address - Fax:218-722-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110498OtherUCARE MINNESOTA
MN1891784062Medicaid
MN111276OtherUCARE MINNESOTA
MN21-00559OtherMEDICA
MN1891784062OtherBLUE CROSS BLUE SHEILD OF MINNESOTA
MN1891784062OtherBLUE PLUS OF MINNESOTA
MN22-00240OtherMEDICA
MN61773OtherHEALTHPARTNERS
MN1891784062OtherFIRST PLAN BLUE
MN61773OtherHEALTHPARTNERS
MN1891784062Medicare UPIN