Provider Demographics
NPI:1063034924
Name:NELSON, LINDSEY (OD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:580 LAKES EDGE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5227
Mailing Address - Country:US
Mailing Address - Phone:248-891-1349
Mailing Address - Fax:
Practice Address - Street 1:116 N TUSCOLA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6961
Practice Address - Country:US
Practice Address - Phone:989-892-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist