Provider Demographics
NPI:1134240443
Name:FERICKS, SEAN RUSSELL (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:RUSSELL
Last Name:FERICKS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 MOUNTAIN CITY HIGHWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2459
Mailing Address - Country:US
Mailing Address - Phone:775-738-6727
Mailing Address - Fax:
Practice Address - Street 1:1657 MOUNTAIN CITY HIGHWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2459
Practice Address - Country:US
Practice Address - Phone:775-738-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV396156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician