Provider Demographics
NPI:1891784062
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:RONALD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
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:2005-10-19
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2100559OtherMEDICA GLASSES
74610NOOtherFIRST PLAN BLUE
MN794562100Medicaid
MN110498OtherUCARE MN GLASSES
MN2200240OtherMEDICA VISION
HP29194OtherHEALTH PARTNERS VISION
MN111276OtherUCARE MN VISION
61773OtherHEALTH PARTNERS GLASSES
MN74610NOOtherBCBS
MN794562100Medicaid