Healthcare Provider Details

I. General information

NPI: 1366639726
Provider Name (Legal Business Name): LINSEY MICHELLE OLIVIER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54425 NORTH CIRCLE DRIVE SUITE 1 & 2
IDYLLWILD CA
92549
US

IV. Provider business mailing address

P.O BOX 1389
IDYLLWILD CA
92549-1389
US

V. Phone/Fax

Practice location:
  • Phone: 951-692-0904
  • Fax:
Mailing address:
  • Phone: 951-692-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 13333 TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: