Provider Demographics
NPI:1194333260
Name:LINDGREN, KELLY ANN FOSTER (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN FOSTER
Last Name:LINDGREN
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 1:1315 N DEQUINCY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1823
Mailing Address - Country:US
Mailing Address - Phone:765-702-9456
Mailing Address - Fax:
Practice Address - Street 1:1298 US 31 N
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4501
Practice Address - Country:US
Practice Address - Phone:317-885-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004235A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist