Provider Demographics
NPI:1790168995
Name:WILL, LINDEN (OD)
Entity Type:Individual
Prefix:DR
First Name:LINDEN
Middle Name:
Last Name:WILL
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 1:1633 CARPENTER ST
Mailing Address - Street 2:APT A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2051
Mailing Address - Country:US
Mailing Address - Phone:484-333-0422
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST
Practice Address - Street 2:SUITE 600
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4017
Practice Address - Country:US
Practice Address - Phone:215-735-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist