Provider Demographics
NPI:1255473948
Name:PRICE, LYNDA ELAINE (OD)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:ELAINE
Last Name:PRICE
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 1:2919 ACORN COURT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-6739
Mailing Address - Country:US
Mailing Address - Phone:812-476-1027
Mailing Address - Fax:
Practice Address - Street 1:800 N GREEN RIVER ROAD
Practice Address - Street 2:EASTLAND MALL
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2471
Practice Address - Country:US
Practice Address - Phone:812-477-4356
Practice Address - Fax:812-477-4381
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002163A152W00000X
IN18002163B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T35102Medicare UPIN