MEDICARE: LINDSEY WILLIS SUELFLOW O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	7970T	TX

General Provider Information

NPI Number	:	1083979546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY WILLIS SUELFLOW O.D.

Provider Business Mailing Address
First Line	:	5858 W MAIN ST
Second Line	:	SUITE 110
City	:	FRISCO
State	:	TX
Zip	:	75033-4193
Country	:	US
Telephone Number	:	469-633-9339
Fax Number	:

Provider Business Practice Location Address
First Line	:	5858 W MAIN ST
Second Line	:	SUITE 110
City	:	FRISCO
State	:	TX
Zip	:	75033-4193
Country	:	US
Telephone Number	:	469-633-9339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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