Provider Demographics
NPI:1558453753
Name:VIRGINIA R LIND & RONALD L LIND LIND VIRGINIA R GEN PTR
Entity Type:Organization
Organization Name:VIRGINIA R LIND & RONALD L LIND LIND VIRGINIA R GEN PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-456-8028
Mailing Address - Street 1:59 COLLEGE ROAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-1757
Mailing Address - Country:US
Mailing Address - Phone:907-456-8028
Mailing Address - Fax:907-456-8028
Practice Address - Street 1:59 COLLEGE ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-1757
Practice Address - Country:US
Practice Address - Phone:907-456-8028
Practice Address - Fax:907-456-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD0133Medicaid
AKOD0133Medicaid
AK153317Medicare ID - Type UnspecifiedGROUP ID