Provider Demographics
NPI:1366639726
Name:OLIVIER, LINSEY MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:LINSEY
Middle Name:MICHELLE
Last Name:OLIVIER
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:P.O BOX 1389
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-1389
Mailing Address - Country:US
Mailing Address - Phone:951-692-0904
Mailing Address - Fax:
Practice Address - Street 1:54425 NORTH CIRCLE DRIVE
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549
Practice Address - Country:US
Practice Address - Phone:951-692-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13333 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0133330Medicare PIN
0286940001Medicare NSC
1053492744Medicare PIN