Healthcare Provider Details

I. General information

NPI: 1255438057
Provider Name (Legal Business Name): DIANE MICHELE LINDSAY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

1 FREEDOM WAY
AUGUSTA GA
30904-6258
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-481-6703
Mailing address:
  • Phone: 706-733-0188
  • Fax: 706-481-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2095
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS797-TA-342
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: