Provider Demographics
NPI:1033149919
Name:LINDBERG, GRANT EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:EDWARD
Last Name:LINDBERG
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 1:12310 NE 8TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3185
Mailing Address - Country:US
Mailing Address - Phone:425-455-0001
Mailing Address - Fax:425-462-7387
Practice Address - Street 1:12310 NE 8TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3185
Practice Address - Country:US
Practice Address - Phone:425-455-0001
Practice Address - Fax:425-462-7387
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021590Medicaid
WAG000105359Medicare PIN
WAU70423Medicare UPIN
WA0551250001Medicare NSC