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General NPI Number Information
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NPI Number | 1497785620
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Entity Type | Organization
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Legal Business Name | DON SEALOCK, O.D., P.A.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 4455 HIGHWAY 169 N
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City | PLYMOUTH
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State | MN
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Zip | 55442-2897
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Country | US
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Telephone | 763-559-7358
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Fax | 763-559-2167
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Provider Business Mailing Address
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Address Line | 4455 HIGHWAY 169 N
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City | PLYMOUTH
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State | MN
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Zip | 55442-2897
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Country | US
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Telephone | 763-559-7358
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Fax | 763-559-2167
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD H SEALOCK
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Credential | O.D.
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Telephone | 763-559-7358
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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 | 2103
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License Number State | MN
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