BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D. — NPI 1629137419 (Licensed & Credentialed Eye & Vision Service Providers — Technician — Technologist, Optician in TWO HARBORS, MN)

CMS-1500 Box 24J / 33a • NPI

1629137419

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

156FX1800X (CMS 96[5])

Licensed & Credentialed Eye & Vision Service Providers — Technician — Technologist, Optician

Box 32 Service Location & ZIP+4

802 11TH ST, STE A, TWO HARBORS, MN, 55616-1413

✓ 9-Digit EDI 837 ZIP+4 (55616-1413)

Practice Phone & Referral Fax

(218) 834-8070

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1629137419 (BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1629137419` (NPI-2 Organization / Facility)
Provider / Legal Name	BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D.
Plain-English Specialty	Licensed & Credentialed Eye & Vision Service Providers — Technician — Technologist, Optician NUCC Code: `156FX1800X` (Technician/Technologist, Optician)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	802 11TH ST, STE A, TWO HARBORS, MN, 55616-1413
Practice Telephone / Fax	Tel: (218) 834-8070
Administrative Mailing Address	802 11TH ST STE A, TWO HARBORS, MN, 55616-1413
Enumeration & Last Sync	Enumerated: 2006-12-07 \| CMS Record Updated: 2020-08-22
Authorized Official	ANNE ANDERSON (manager)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

802 11TH ST, STE A, TWO HARBORS, MN, 55616-1413

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Plain-English Taxonomy & CMS Crosswalk (156FX1800X)

What Does Taxonomy Code 156FX1800X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 156FX1800X translates to:
"Licensed & Credentialed Eye & Vision Service Providers — Technician — Technologist, Optician"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 96[5] (Optician)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Technician/Technologist, Optician for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`156FX1800X` — Technician/Technologist, Optician Plain English: Licensed & Credentialed Eye & Vision Service Providers — Technician — Technologist, Optician	State: MN \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BLUSTIN OPTICAL CENTER DBA DERIN J VAN LOON, O.D. (NPI #1629137419)