Provider Demographics
NPI:1508867433
Name:LIND, JEFFREY CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:LIND
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 1:7129 NE IMBRIE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7594
Mailing Address - Country:US
Mailing Address - Phone:503-690-2020
Mailing Address - Fax:503-645-0548
Practice Address - Street 1:7129 NE IMBRIE DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:503-690-2020
Practice Address - Fax:503-645-0548
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1491 AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR105163Medicaid
ORR0000PGDFFMedicare PIN
OR105163Medicaid
OR0194940001Medicare NSC