Provider Demographics
NPI:1073736195
Name:LINDSAY OPTICAL
Entity Type:Organization
Organization Name:LINDSAY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICAL
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:912-393-3937
Mailing Address - Street 1:316 GASKIN AVE S
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-0015
Mailing Address - Country:US
Mailing Address - Phone:912-393-3937
Mailing Address - Fax:912-393-3944
Practice Address - Street 1:316 GASKIN AVE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-0015
Practice Address - Country:US
Practice Address - Phone:912-393-3937
Practice Address - Fax:912-393-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001756156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1286180001Medicare ID - Type UnspecifiedPALMETTO GOVERMENT