Provider Demographics
NPI:1821118399
Name:LINDEN OPTICAL
Entity Type:Organization
Organization Name:LINDEN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MARSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-391-7898
Mailing Address - Street 1:PO BOX 2728
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61132-2728
Mailing Address - Country:US
Mailing Address - Phone:815-391-7898
Mailing Address - Fax:815-391-7897
Practice Address - Street 1:1215 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-2201
Practice Address - Country:US
Practice Address - Phone:815-391-7898
Practice Address - Fax:815-391-7897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty