1922363589 NPI number — MRS. LYNDSAY LEIGH OLMSTEAD O.D.

Table of content: MRS. LYNDSAY LEIGH OLMSTEAD O.D. (NPI 1922363589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922363589 NPI number — MRS. LYNDSAY LEIGH OLMSTEAD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLMSTEAD
Provider First Name:
LYNDSAY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOMKINS
Provider Other First Name:
LYNDSAY
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922363589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
932 SPRING STREET
Provider Second Line Business Mailing Address:
UNIT 101
Provider Business Mailing Address City Name:
PETOSKEY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-487-5315
Provider Business Mailing Address Fax Number:
231-487-5316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
932 SPRING STREET
Provider Second Line Business Practice Location Address:
UNIT 101
Provider Business Practice Location Address City Name:
PETOSKEY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-487-5315
Provider Business Practice Location Address Fax Number:
231-487-5316
Provider Enumeration Date:
07/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4901004701 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 4901004701 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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