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General NPI Number Information
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NPI Number | 1477764785
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Entity Type | Organization
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Legal Business Name | SEAN G. BLACKBURN, O.D.
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 836 18TH AVE
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City | SIDNEY
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State | NE
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Zip | 69162-1402
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Country | US
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Telephone | 308-254-3225
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Fax | 308-254-0210
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Provider Business Mailing Address
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Address Line | 836 18TH AVE
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City | SIDNEY
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State | NE
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Zip | 69162-1402
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Country | US
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Telephone | 308-254-3225
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Fax | 308-254-0210
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DENISE L HUSON
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Credential |
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Telephone | 308-254-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1066
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License Number State | NE
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