Provider Demographics
NPI:1225253149
Name:LINDSAY VISION CENTER, PLLC
Entity Type:Organization
Organization Name:LINDSAY VISION CENTER, PLLC
Other - Org Name:MIKE BOECKMAN, O.D., PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BOECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-756-4414
Mailing Address - Street 1:301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-5635
Mailing Address - Country:US
Mailing Address - Phone:405-756-4414
Mailing Address - Fax:405-756-4415
Practice Address - Street 1:301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-5635
Practice Address - Country:US
Practice Address - Phone:405-756-4414
Practice Address - Fax:405-756-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK 1041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100761590AMedicaid
OKT40364Medicare UPIN
OK5103020001Medicare NSC
OK440665684Medicare PIN