Provider Demographics
NPI:1417205352
Name:MARVEL, LINDSEY RENEE (OD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RENEE
Last Name:MARVEL
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 1:17217 SADDLECREEK WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7417
Mailing Address - Country:US
Mailing Address - Phone:405-509-3913
Mailing Address - Fax:
Practice Address - Street 1:425 7TH STREET NW
Practice Address - Street 2:CASS LAKE INDIAN HOSPITAL ,
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:405-509-3913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNOPT-OPT-LIC-1620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist