Provider Demographics
NPI:1427018282
Name:CLYDE, LINDSEY MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:MICHELLE
Last Name:CLYDE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 E NORTHERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4188
Mailing Address - Country:US
Mailing Address - Phone:602-242-6888
Mailing Address - Fax:602-242-4654
Practice Address - Street 1:1111 E NORTHERN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4188
Practice Address - Country:US
Practice Address - Phone:602-242-6888
Practice Address - Fax:602-242-4654
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2497152W00000X, 152WP0200X, 152WS0006X
AZ1522152W00000X, 152WP0200X, 152WS0006X, 156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter