Provider Demographics
NPI:1124165089
Name:O'NEILL, SEAN PATRICK (OD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:O'NEILL
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 1:421 WHISPERING WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9448
Mailing Address - Country:US
Mailing Address - Phone:319-624-4009
Mailing Address - Fax:
Practice Address - Street 1:1614 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6044
Practice Address - Country:US
Practice Address - Phone:319-337-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2450Medicare PIN