Provider Demographics
NPI:1376281451
Name:LINDAUER, JAXON DRAKE (OD)
Entity type:Individual
Prefix:DR
First Name:JAXON
Middle Name:DRAKE
Last Name:LINDAUER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E HASTINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1963
Mailing Address - Country:US
Mailing Address - Phone:509-328-2632
Mailing Address - Fax:
Practice Address - Street 1:513 E HASTINGS RD STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1963
Practice Address - Country:US
Practice Address - Phone:509-328-2632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61317041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist