Provider Demographics
NPI:1689367401
Name:DESPIN, SEAN (LDO 6789)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:DESPIN
Suffix:
Gender:M
Credentials:LDO 6789
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-2541
Mailing Address - Country:US
Mailing Address - Phone:850-526-0067
Mailing Address - Fax:850-526-0069
Practice Address - Street 1:2255 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-2541
Practice Address - Country:US
Practice Address - Phone:850-526-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6789156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician