Provider Demographics
NPI:1235105552
Name:CLAFLIN, SEAN R (O D)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:CLAFLIN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2411
Mailing Address - Country:US
Mailing Address - Phone:719-276-1660
Mailing Address - Fax:719-276-1662
Practice Address - Street 1:1924 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2411
Practice Address - Country:US
Practice Address - Phone:719-276-1660
Practice Address - Fax:719-276-1662
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 1551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08015513Medicaid
COU46442Medicare UPIN
CO1214360001Medicare NSC
CO08015513Medicaid