Provider Demographics
NPI:1396940920
Name:STULL, LINDSEY (OD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:STULL
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 1:1891 BAY SCOTT CIR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1137
Mailing Address - Country:US
Mailing Address - Phone:630-881-7763
Mailing Address - Fax:
Practice Address - Street 1:1891 BAY SCOTT CIR
Practice Address - Street 2:SUITE 109
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1137
Practice Address - Country:US
Practice Address - Phone:630-881-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010926152WV0400X
MI4901004454152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy