Provider Demographics
NPI:1962283499
Name:MITCHELL, LINDZY (LDO)
Entity type:Individual
Prefix:
First Name:LINDZY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 E MARYLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1527
Mailing Address - Country:US
Mailing Address - Phone:480-861-7338
Mailing Address - Fax:
Practice Address - Street 1:3721 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7507
Practice Address - Country:US
Practice Address - Phone:602-685-0330
Practice Address - Fax:602-685-0404
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2877I156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician