Provider Demographics
NPI:1801411251
Name:FUENTES, LINDSAY (OD)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:
Last Name:FUENTES
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 1:1951 SW 172ND AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5614
Mailing Address - Country:US
Mailing Address - Phone:954-437-4316
Mailing Address - Fax:954-437-4352
Practice Address - Street 1:1951 SW 172ND AVE STE 304
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5614
Practice Address - Country:US
Practice Address - Phone:954-437-4316
Practice Address - Fax:954-437-4352
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist