Provider Demographics
NPI:1720278773
Name:DENTON, LINDSAY ELISHA (OD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ELISHA
Last Name:DENTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ELISHA
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1344 W. ARROWHEAD RD.
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-728-6211
Mailing Address - Fax:218-724-1833
Practice Address - Street 1:271 FORT RICHARDSON AVE
Practice Address - Street 2:OPTOMETRY CLINIC
Practice Address - City:GOODFELLOW AFB
Practice Address - State:TX
Practice Address - Zip Code:76908-4901
Practice Address - Country:US
Practice Address - Phone:325-654-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7097T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist