Provider Demographics
NPI:1780724583
Name:LINDSTROM EYE & LASER CENTER, P.A.
Entity type:Organization
Organization Name:LINDSTROM EYE & LASER CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-428-0999
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0407
Mailing Address - Country:US
Mailing Address - Phone:601-426-9454
Mailing Address - Fax:601-426-9476
Practice Address - Street 1:1020 ADAMS ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4365
Practice Address - Country:US
Practice Address - Phone:601-426-9454
Practice Address - Fax:601-426-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013550Medicaid
MSB30517Medicare UPIN
MS09013550Medicaid
MSC00910Medicare ID - Type Unspecified