Provider Demographics
NPI:1891784047
Name:LIND, AUTUMN O (OD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:O
Last Name:LIND
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 1:107 JAMES COLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3100
Mailing Address - Country:US
Mailing Address - Phone:361-578-0234
Mailing Address - Fax:361-578-3812
Practice Address - Street 1:107 JAMES COLEMAN DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3100
Practice Address - Country:US
Practice Address - Phone:361-578-0234
Practice Address - Fax:361-578-3812
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6599TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03362Medicare UPIN
TX8G9198Medicare PIN