Healthcare Provider Details

I. General information

NPI: 1740262765
Provider Name (Legal Business Name): ROBIN RAY LINDAUER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W HONEYSUCKLE AVE
HAYDEN ID
83835-6042
US

IV. Provider business mailing address

3204 E FERNAN HILL RD
COEUR D ALENE ID
83814-7728
US

V. Phone/Fax

Practice location:
  • Phone: 208-209-4078
  • Fax:
Mailing address:
  • Phone: 208-659-8902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP751
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: