Provider Demographics
NPI:1407896400
Name:LINDQUIST, JOHN T (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3869 STOCKDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2188
Mailing Address - Country:US
Mailing Address - Phone:661-831-8952
Mailing Address - Fax:661-831-5042
Practice Address - Street 1:3869 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2188
Practice Address - Country:US
Practice Address - Phone:661-831-8952
Practice Address - Fax:661-831-5042
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5732T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T10100Medicare UPIN
SD0057320Medicare ID - Type Unspecified