BLAINE EYE CLINIC
NPI 1043363401
Durable Medical Equipment & Medical Supplies in Blaine, MN
NPI Status: Active since January 19, 2007
Contact Information
12170 ABERDEEN ST NE
BLAINE, MN
ZIP 55449
Phone: (763) 757-7000
Fax: (763) 757-3328
- Organization
- Durable Medical Equipment & Medical Supp...
- Accepts Insurance
- Medicare Supplier
- Accepts Medicare Approved Payment
- CLIA Number: 24D2228198
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 06-22-2027
About BLAINE EYE CLINIC
This page provides the complete NPI Profile along with additional information for Blaine Eye Clinic, a provider established in Blaine, Minnesota operating as a Durable Medical Equipment & Medical Supplies. The healthcare provider is registered in the NPI registry with number 1043363401 assigned on January 2007. The practitioner's primary taxonomy code is 332B00000X. The provider is registered as an organization and their NPI record was last updated 15 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Blaine Eye Clinic. The authorized official of this NPI record is Lynn Alan Sulerud O.d. (Owner)
- NPI
- 1043363401
- Provider Legal Name
- BLAINE EYE CLINIC OPTOMETRISTS, P.A.
- Other Organization Name
- BLAINE EYE CLINIC
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 12170 ABERDEEN ST NE BLAINE, MN 55449
- Location Phone
- (763) 757-7000
- Location Fax
- (763) 757-3328
- Mailing Address
- 12170 ABERDEEN ST NE BLAINE, MN 55449
- Mailing Phone
- (763) 757-7000
- Mailing Fax
- (763) 757-3328
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-19-2007
- Last Update Date
- 02-15-2011
- Code Navigator
Blaine Eye Clinic is a medicare supplier with PTAN 20677937 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Prosthetic Lenses: Conventional Eyeglasses or Prosthetic Lenses: Conventional Contact Lenses or Prosthetic Lenses: Prosthetics Cataract Lenses.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Durable Medical Equipment & Medical Supplies
- Taxonomy Code
- 332B00000X
- Type
- Suppliers
- License State
- MN
- Taxonomy Description
- A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 152W00000X | Eye and Vision Services Providers | Optometrist | (MN) |
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Atlas $1,300 Gold - PPO
- Atlas $2,000 Standard Gold - PPO
- Atlas $3,050 Plus Silver - PPO
- Atlas $3,800 HSA Silver - PPO
- Atlas $6,000 Standard Silver - PPO
- Atlas $6,800 Plus Bronze HSA - PPO
- Atlas $7,500 Standard Bronze HSA - PPO
- Atlas $8,400 HSA Bronze - PPO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze Share - HMO
- Medica Individual Choice Expanded Bronze Standard - HMO
- Medica Individual Choice Gold $0 Copay PCP Visits - HMO
- Medica Individual Choice Gold Share - HMO
- Medica Individual Choice Gold Standard - HMO
- Medica Individual Choice Silver $0 Copay PCP Visits - HMO
- Medica Individual Choice Silver Share - HMO
- Medica Individual Choice Silver Standard - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 221526800 | MEDICAID (05) | MN | |
| 1043363401 | MEDICARE PIN (08) | MN | |
| T66186 | MEDICARE UPIN (02) | MN | |
| DB3402 | OTHER (01) | MN | RAILROAD MEDICARE |
| 0404250001 | MEDICARE NSC (07) | MN |
Medical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20677937
- Accepts Medicare Assignment
- YES
- Specialities List
- Optometrist, Optician.
- Competitive Bidding
- NO
Supplies List
- Prosthetic Lenses: Conventional Eyeglasses - Conventional Eyeglasses
- Prosthetic Lenses: Conventional Contact Lenses - Conventional Contact Lenses
- Prosthetic Lenses: Prosthetics Cataract Lenses - Cataract Eyeglasses
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D2228198
- Facility Type
- Physician Office
- Certificate Effective Date
- June 23, 2025
- Certificate Expiration Date
- June 22, 2027
- Laboratory Director
- BREANN M. FORLITI
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Blaine Eye Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1043363401, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 8 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1043363401, enumerated as an "organization" on January 19, 2007.
The provider is located at 12170 ABERDEEN ST NE BLAINE, MN 55449 and the phone number is (763) 757-7000.
Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.
The provider might be accepting Accepts: HealthPartners, Medica, Medicare, Medicaid and. Please consult your insurance carrier or call the provider to verify.
