Provider Demographics
NPI:1215551759
Name:LINDAHL, AMBER (OD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LINDAHL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 LADSON TER
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7726
Mailing Address - Country:US
Mailing Address - Phone:561-767-0651
Mailing Address - Fax:
Practice Address - Street 1:6380 W INDIANTOWN RD STE 14
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7979
Practice Address - Country:US
Practice Address - Phone:561-842-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005793152WC0802X, 152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC005793OtherFLORIDA BOARD OF OPTOMETRY