Healthcare Provider Details

I. General information

NPI: 1710264072
Provider Name (Legal Business Name): SETH DEAN BALDWIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 FOUNTAIN MESA RD
FOUNTAIN CO
80817-1535
US

IV. Provider business mailing address

7975 FOUNTAIN MESA RD
FOUNTAIN CO
80817-1535
US

V. Phone/Fax

Practice location:
  • Phone: 719-573-2020
  • Fax: 719-301-4114
Mailing address:
  • Phone: 719-573-2020
  • Fax: 719-301-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3757
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7884
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberAZ2193
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: