Provider Demographics
NPI:1114079928
Name:SEWELL, LINDSEY K (OD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:K
Last Name:SEWELL
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 1:10516 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8745
Mailing Address - Country:US
Mailing Address - Phone:360-307-7400
Mailing Address - Fax:
Practice Address - Street 1:10516 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8745
Practice Address - Country:US
Practice Address - Phone:360-307-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2027563Medicaid
WA233732OtherL&I
WAT01764Medicare UPIN
WA2027563Medicaid
WAG000166377Medicare PIN