Provider Demographics
NPI:1487740882
Name:COLLINS, LINDA M (OD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:COLLINS
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 1:35 EAST GRASSY SPRAIN RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710
Mailing Address - Country:US
Mailing Address - Phone:914-395-0336
Mailing Address - Fax:
Practice Address - Street 1:35 EAST GRASSY SPRAIN RD
Practice Address - Street 2:SUITE 307
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710
Practice Address - Country:US
Practice Address - Phone:914-395-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005215-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY44991Medicare ID - Type Unspecified
NYU29155Medicare UPIN