Provider Demographics
NPI:1790217503
Name:SARAZEN, SEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:SARAZEN
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 1:223407 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-6637
Mailing Address - Country:US
Mailing Address - Phone:715-571-5697
Mailing Address - Fax:
Practice Address - Street 1:2727 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4129
Practice Address - Country:US
Practice Address - Phone:715-841-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI3465-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program