Provider Demographics
NPI:1013586742
Name:FUNDERBURK, LINDSEY (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:
Last Name:FUNDERBURK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:CAUDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1823 CROWE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-7264
Mailing Address - Country:US
Mailing Address - Phone:423-623-3875
Mailing Address - Fax:
Practice Address - Street 1:1823 CROWE LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-7264
Practice Address - Country:US
Practice Address - Phone:423-623-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3677OtherOPTOMETRY LICENSE NUMBER
TNMC6596196OtherDEA NUMBER