Provider Demographics
NPI:1659330231
Name:ALDINGER, SEAN PHILLIP (OD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PHILLIP
Last Name:ALDINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6947 CRUMPLER BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1922
Mailing Address - Country:US
Mailing Address - Phone:662-893-3300
Mailing Address - Fax:662-893-3301
Practice Address - Street 1:6947 CRUMPLER BLVD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1922
Practice Address - Country:US
Practice Address - Phone:662-893-3300
Practice Address - Fax:662-893-3301
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS681152W00000X
TN2481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7018 #1OtherDAVIS VISION
MSAL1564575OtherCALRITY VISION
MSAL1564575OtherCALRITY VISION
MS410000271Medicare ID - Type Unspecified