Provider Demographics
NPI:1326153065
Name:LIND, MEGAN E (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:E
Last Name:LIND
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 1:6412 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2015
Mailing Address - Country:US
Mailing Address - Phone:414-774-2020
Mailing Address - Fax:
Practice Address - Street 1:6412 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2015
Practice Address - Country:US
Practice Address - Phone:414-774-2020
Practice Address - Fax:414-774-0530
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3057-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIV11509Medicare UPIN
WI875400004Medicare PIN