Provider Demographics
NPI:1659623056
Name:MARTIN, LINDSEY DENISON (OD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DENISON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:810 KNIGHTS CROSS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2981
Mailing Address - Country:US
Mailing Address - Phone:210-495-9020
Mailing Address - Fax:210-495-9398
Practice Address - Street 1:19202 STONE OAK PKWY
Practice Address - Street 2:STE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3286
Practice Address - Country:US
Practice Address - Phone:210-495-9020
Practice Address - Fax:210-495-9398
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8071152W00000X
TX8071TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX264689YQLBMedicare PIN