NPIMap

Organization Active NPI

Don Sealock, O.D., P.a.

Doing business as Four Seasons Eyecare

  • Optometrist
  • Plymouth, MN
National Provider Identifier
1497785620
Registry record updated Sep 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2103 Issued in MN
Legal business name
DON SEALOCK, O.D., P.A.
Doing business as
Four Seasons Eyecare
Practice address
4455 Highway 169 N
Plymouth, MN 55442-2897
Phone
(763) 559-7358
Fax
(763) 559-2167
NPI assigned
Jul 4, 2006
Last updated
Sep 26, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Donald H Sealock, O.D.NPI 1427018266
Title
President
Phone
(763) 559-7358

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2103 MN Primary

Addresses

Primary practice location

4455 Highway 169 N
Plymouth, MN 55442-2897

Mailing address

4455 Highway 169 N
Plymouth, MN 55442-2897
Phone (763) 559-7358

Other names 1

  • Four Seasons Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050506000613 MN Part B Supplier - Clinic/Group Practice 5092755215 Receives reassigned benefits from 7 practitioners
Practice locations: Plymouth, MN; Watertown, MN
O20100930052698 MN DME Supplier - Physician - Optometrist 5092755215 Practice locations: Plymouth, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Four Seasons Eyecare4455 Highway 169 N, Plymouth, MN 55442-2898(763) 559-7358 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1995

National Provider Directory

National Provider Directory
Tax ID family
Don Sealock OD PA10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

621 Rose Dr
Big Lake, MN 55309
Phone (763) 263-8444

1313 Highway 25 N
Buffalo, MN 55313
Phone (763) 682-2020

94 14th St NE
Buffalo, MN 55313

94 14th St NE
Ste 3
Buffalo, MN 55313
Phone (763) 746-3391

1326 Babcock Blvd E
Delano, MN 55328
Phone (763) 972-2979

405 Babcock Blvd E
Delano, MN 55328
Phone (763) 972-2979

405 Babcock Blvd E
Ste 150
Delano, MN 55328

9825 Hospital Dr
Ste 106
Maple Grove, MN 55369
Phone (763) 568-7177

14408 Excelsior Blvd
Minnetonka, MN 55345
Phone (952) 433-7107

14411 Excelsior Blvd
Minnetonka, MN 55345
Phone (952) 933-7107

14451 Highway 7
Ste 102
Minnetonka, MN 55345

4455 Highway 169 N
Ste 100
Plymouth, MN 55442
Phone (763) 559-7358

4455 Highway 169 N
Ste 111
Plymouth, MN 55442
Phone (763) 559-7358

698 Central Ave E
Saint Michael, MN 55376

309 Jefferson Ave SW
Watertown, MN 55388
Phone (952) 955-1921

Ownership & related parties

Subparts reporting this organization as parent 9

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1497785620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 HIGHWAY 169 N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554422897",
            "telephone_number": "763-559-7358",
            "fax_number": "763-559-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 HIGHWAY 169 N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554422897",
            "telephone_number": "763-559-7358",
            "fax_number": "763-559-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DON SEALOCK, O.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "SEALOCK",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-559-7358",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Seasons Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.