Provider Demographics
NPI:1699904581
Name:PETRIE, LINDSAY MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:MARIE
Last Name:PETRIE
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 1:1039 CORNERSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:ALLONS
Mailing Address - State:TN
Mailing Address - Zip Code:38541-6858
Mailing Address - Country:US
Mailing Address - Phone:847-275-9404
Mailing Address - Fax:
Practice Address - Street 1:30 CROSSING LN STE 107
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-6354
Practice Address - Country:US
Practice Address - Phone:540-463-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist