Provider Demographics
NPI:1144201500
Name:LINDELL, DEREK C (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:C
Last Name:LINDELL
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:MR
Other - First Name:DEREK
Other - Middle Name:C
Other - Last Name:LINDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:10423 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3757
Mailing Address - Country:US
Mailing Address - Phone:718-275-2500
Mailing Address - Fax:718-275-9654
Practice Address - Street 1:10423 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3757
Practice Address - Country:US
Practice Address - Phone:718-275-2500
Practice Address - Fax:718-275-9654
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003810-0156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician