Provider Demographics
NPI:1780676361
Name:LINDLEY, LEW L (OD)
Entity type:Individual
Prefix:DR
First Name:LEW
Middle Name:L
Last Name:LINDLEY
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 1:8456 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4010
Mailing Address - Country:US
Mailing Address - Phone:520-885-2052
Mailing Address - Fax:520-886-7488
Practice Address - Street 1:8456 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4010
Practice Address - Country:US
Practice Address - Phone:520-885-2052
Practice Address - Fax:520-886-7488
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-06-25
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AZ135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist