Healthcare Provider Details

I. General information

NPI: 1568183440
Provider Name (Legal Business Name): SEAN MA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13695 COLORADO BLVD
THORNTON CO
80602-7051
US

IV. Provider business mailing address

2060 KLINE ST
LAKEWOOD CO
80215-1411
US

V. Phone/Fax

Practice location:
  • Phone: 303-450-2020
  • Fax: 303-920-1440
Mailing address:
  • Phone: 626-625-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3975
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: