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General NPI Number Information
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NPI Number | 1831651165
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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 | 04/04/2019
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 3366 OAKDALE AVE N STE 140
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City | ROBBINSDALE
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State | MN
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Zip | 55422-2961
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Country | US
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Telephone | 763-292-5746
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Fax | 763-292-5748
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Provider Business Mailing Address
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Address Line | 4455 HIGHWAY 169 N STE 100
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City | PLYMOUTH
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State | MN
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Zip | 55442-2898
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Country | US
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Telephone | 612-387-8920
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Fax |
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Authorized Official
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Title or Position | SECR/TREAS
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Name | JENNIE J SEALOCK
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Credential |
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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