Don Sealock, O.D., P.a.
Organization Active NPI Optometrist · Plymouth, MN
NPI 1497785620 · NPPES record last updated Sep 26, 2016
Key facts
- NPI
- 1497785620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2103 (MN)
- Legal business name
- DON SEALOCK, O.D., P.A.
- Practice address
- 4455 Highway 169 N
Plymouth, MN 55442-2897 - Phone
- (763) 559-7358
- Fax
- (763) 559-2167
- NPI assigned
- Jul 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Donald H Sealock, O.D.
- Title
- President
- Phone
- (763) 559-7358
Subparts reporting this organization as parent 9
Corporate family (same tax ID) 9
Practitioners 19
-
Grant Sealock, OD
-
Lauren Evans, OD
-
Bryce D Sealock, OD
-
Donald H Sealock, OD
-
Nicole Ann Solem, OD
-
Trent D Cole, OD
-
Timothy J Hurley, OD
-
Kevin F Jund, OD
-
Jessica Loehr, OPTOMETRIST
-
Troy D Loomis, OD
-
Andrew Mattson, O.D.
-
Jeffrey Paul Sanderson, M.D.
-
Rosamond Hannah Tedesco, O.D.
-
Heather Anne Noel Tuttle, O.D.
-
Philip J Hasler, OD
-
Barbara J Lee, O.D.
-
Troy A Moats, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Four Seasons Eyecare |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Don Sealock OD PA
Locations
94 14th St NE
Buffalo, MN 55313
94 14th St NE
Ste 3
Buffalo, MN 55313
Phone (763) 746-3391
1313 Highway 25 N
Buffalo, MN 55313
Phone (763) 682-2020
94 14th St NE
Ste 2
Buffalo, MN 55313
Phone (763) 682-2020
1326 Babcock Blvd E
Delano, MN 55328
Phone (763) 972-2979
405 Babcock Blvd E
Ste 150
Delano, MN 55328
405 Babcock Blvd E
Delano, MN 55328
Phone (763) 972-2979
14411 Excelsior Blvd
Minnetonka, MN 55345
Phone (952) 933-7107
14408 Excelsior Blvd
Minnetonka, MN 55345
Phone (952) 433-7107
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2103 | MN | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 496562100 | Medicaid | MN |
Other names
- Four Seasons Eyecare
Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.