Provider Demographics
NPI:1811587892
Name:VAN, LINDSEY (OD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:VAN
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 1:4900 SUNNYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1047
Mailing Address - Country:US
Mailing Address - Phone:714-310-3247
Mailing Address - Fax:
Practice Address - Street 1:23600 EL TORO RD STE A
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4710
Practice Address - Country:US
Practice Address - Phone:949-330-8119
Practice Address - Fax:949-470-3236
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT34727-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist