Provider Demographics
NPI:1295284735
Name:DON SEALOCK, O.D., P.A.
Entity type:Organization
Organization Name:DON SEALOCK, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECR/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-551-0529
Mailing Address - Street 1:94 14TH ST NE
Mailing Address - Street 2:STE 2
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1932
Mailing Address - Country:US
Mailing Address - Phone:763-682-2020
Mailing Address - Fax:763-682-5899
Practice Address - Street 1:94 14TH ST NE
Practice Address - Street 2:STE 2
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1932
Practice Address - Country:US
Practice Address - Phone:763-682-2020
Practice Address - Fax:763-682-5899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DON SEALOCK, O.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier