Provider Demographics
NPI:1063145779
Name:LINDSAY, KRISSA JANAE (OD)
Entity type:Individual
Prefix:
First Name:KRISSA
Middle Name:JANAE
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26369 N 107TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-9807
Mailing Address - Country:US
Mailing Address - Phone:760-881-9088
Mailing Address - Fax:
Practice Address - Street 1:17550 N 79TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8711
Practice Address - Country:US
Practice Address - Phone:623-776-4006
Practice Address - Fax:623-776-4028
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist