Provider Demographics
NPI:1144223579
Name:PHIBBS, SEAN PATRICK (OD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:PHIBBS
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 1:701 SEA GIRT AVE
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-2803
Mailing Address - Country:US
Mailing Address - Phone:732-974-3937
Mailing Address - Fax:732-974-6899
Practice Address - Street 1:701 SEA GIRT AVE
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-2803
Practice Address - Country:US
Practice Address - Phone:732-974-3937
Practice Address - Fax:732-974-6899
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ4756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521682YX7GMedicare PIN
NJPH521682Medicare ID - Type Unspecified
NJ7178409Medicaid