Provider Demographics
NPI:1184008252
Name:LABELLE, LINDSAY MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:MARIE
Last Name:LABELLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:MARIE
Other - Last Name:GOETZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 W. 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-577-3659
Mailing Address - Fax:248-588-9917
Practice Address - Street 1:4281 24TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3997
Practice Address - Country:US
Practice Address - Phone:810-385-4000
Practice Address - Fax:810-958-7379
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184008252Medicaid