Provider Demographics
NPI:1114339629
Name:BALDUS, LOREN JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:JOHN
Last Name:BALDUS
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 1:3630 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4276
Mailing Address - Country:US
Mailing Address - Phone:507-288-2457
Mailing Address - Fax:
Practice Address - Street 1:3630 11TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4276
Practice Address - Country:US
Practice Address - Phone:507-288-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist