Provider Demographics
NPI:1295082220
Name:DR. DALE P. LINDSEY, O.D., INC.
Entity type:Organization
Organization Name:DR. DALE P. LINDSEY, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-638-8599
Mailing Address - Street 1:122 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1328
Mailing Address - Country:US
Mailing Address - Phone:330-638-8599
Mailing Address - Fax:330-638-8551
Practice Address - Street 1:122 FOWLER ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1328
Practice Address - Country:US
Practice Address - Phone:330-638-8599
Practice Address - Fax:330-638-8551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3679T543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0573786Medicaid
LI0595412OtherPTAN
T48543Medicare UPIN
OH0573786Medicaid