Provider Demographics
NPI:1679132161
Name:OLESAK, LINDSEY ANN (OD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANN
Last Name:OLESAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:ANN
Other - Last Name:LUSARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9336
Mailing Address - Country:US
Mailing Address - Phone:906-241-9251
Mailing Address - Fax:
Practice Address - Street 1:622 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3520
Practice Address - Country:US
Practice Address - Phone:906-226-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist