Provider Demographics
NPI:1104003631
Name:DENNIS LINSEY OD PA
Entity Type:Organization
Organization Name:DENNIS LINSEY OD PA
Other - Org Name:DENNIS LINSEY OD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-926-5700
Mailing Address - Street 1:17633 GUNN HWY
Mailing Address - Street 2:SUITE 364
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1912
Mailing Address - Country:US
Mailing Address - Phone:813-926-5700
Mailing Address - Fax:813-926-7800
Practice Address - Street 1:17633 GUNN HWY
Practice Address - Street 2:SUITE 364
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1912
Practice Address - Country:US
Practice Address - Phone:813-926-5700
Practice Address - Fax:813-926-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0003264152W00000X
FLOP0003305152W00000X
FLOP0002879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0187Medicare PIN