Provider Demographics
NPI:1316957723
Name:HARRIS, LINDSAY R (OD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:R
Last Name:HARRIS
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 1:1275 W 29TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3168
Mailing Address - Country:US
Mailing Address - Phone:215-300-7107
Mailing Address - Fax:
Practice Address - Street 1:450 N ROXBURY DR FL 3
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4232
Practice Address - Country:US
Practice Address - Phone:310-453-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12921T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12921TOtherLICENSE
CA12921TOtherLICENSE