Provider Demographics
NPI:1023620564
Name:MAHANEY, SEAN M (OD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:MAHANEY
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 1:315 SKYRAIDER WAY UNIT 5
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4892
Mailing Address - Country:US
Mailing Address - Phone:719-588-3323
Mailing Address - Fax:
Practice Address - Street 1:1725 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1307
Practice Address - Country:US
Practice Address - Phone:970-221-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003588152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist