Provider Demographics
NPI:1477764785
Name:SEAN G. BLACKBURN, O.D.
Entity Type:Organization
Organization Name:SEAN G. BLACKBURN, O.D.
Other - Org Name:BLACKBURN EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-254-3225
Mailing Address - Street 1:836 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-1402
Mailing Address - Country:US
Mailing Address - Phone:308-254-3225
Mailing Address - Fax:308-254-0210
Practice Address - Street 1:836 18TH AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1402
Practice Address - Country:US
Practice Address - Phone:308-254-3225
Practice Address - Fax:308-254-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE1121550001Medicare NSC