Provider Demographics
NPI:1528048733
Name:HALPIN, SEAN P (OD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:HALPIN
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:PO BOX 7754
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-7080
Mailing Address - Country:US
Mailing Address - Phone:920-830-1011
Mailing Address - Fax:
Practice Address - Street 1:1885 W POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4174
Practice Address - Country:US
Practice Address - Phone:920-232-6550
Practice Address - Fax:920-232-6552
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38599100Medicaid
WI71490-0002Medicare ID - Type Unspecified
410040577Medicare PIN
WI69015-0002Medicare ID - Type Unspecified
WI26020-0002Medicare ID - Type Unspecified
WI38599100Medicaid
410040579Medicare PIN
410040578Medicare PIN