Provider Demographics
NPI:1285017160
Name:AUDETTE, LINDSAY (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:
Last Name:AUDETTE
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 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1 BRICKYARD SQ STE 11
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-4403
Practice Address - Country:US
Practice Address - Phone:603-347-8377
Practice Address - Fax:603-347-8422
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003070152W00000X
NH1010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist