Provider Demographics
NPI:1396947297
Name:LIND, VIRGINIA R (OD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:R
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 1:59 COLLEGE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-1757
Mailing Address - Country:US
Mailing Address - Phone:907-456-8028
Mailing Address - Fax:907-456-8028
Practice Address - Street 1:59 COLLEGE RD STE 209
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-1757
Practice Address - Country:US
Practice Address - Phone:907-456-8028
Practice Address - Fax:907-456-8028
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD0133Medicaid
AKK153319Medicare ID - Type Unspecified
AKOD0133Medicaid