Provider Demographics
NPI:1093783920
Name:LINSEY, GEORGE ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALAN
Last Name:LINSEY
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 1:17633 GUNN HWY
Mailing Address - Street 2:STE 364
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1912
Mailing Address - Country:US
Mailing Address - Phone:813-960-8896
Mailing Address - Fax:813-960-3248
Practice Address - Street 1:12964 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2806
Practice Address - Country:US
Practice Address - Phone:813-960-8896
Practice Address - Fax:813-960-3248
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL#OPC2745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620034600Medicaid
FL40606Medicare ID - Type Unspecified
FL620034600Medicaid
FL20527AMedicare PIN