Provider Demographics
NPI:1710264072
Name:BALDWIN, SETH DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:DEAN
Last Name:BALDWIN
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 1:1111 E NORTHERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4188
Mailing Address - Country:US
Mailing Address - Phone:602-242-6888
Mailing Address - Fax:
Practice Address - Street 1:1111 E NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4188
Practice Address - Country:US
Practice Address - Phone:602-242-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7884152W00000X
AZAZ2193152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist