Provider Demographics
NPI:1740262765
Name:LINDAUER, ROBIN RAY (OD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:RAY
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 1:3204 E FERNAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7728
Mailing Address - Country:US
Mailing Address - Phone:208-659-8902
Mailing Address - Fax:
Practice Address - Street 1:550 W HONEYSUCKLE AVE
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-6042
Practice Address - Country:US
Practice Address - Phone:208-209-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20003141Medicare PIN
T44375Medicare UPIN