Provider Demographics
NPI:1790705242
Name:LINDLEY, ALISA JEAN (OD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:JEAN
Last Name:LINDLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 GREYSTONE SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3576
Mailing Address - Country:US
Mailing Address - Phone:731-668-3424
Mailing Address - Fax:731-668-3425
Practice Address - Street 1:2043 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3576
Practice Address - Country:US
Practice Address - Phone:731-668-3424
Practice Address - Fax:731-668-3425
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4137673OtherBLUE CROSS
TN4137673OtherBLUE CROSS