Healthcare Provider Details

I. General information

NPI: 1194333260
Provider Name (Legal Business Name): KELLY ANN FOSTER LINDGREN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 WABASH AVE
TERRE HAUTE IN
47807-3218
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-0073
  • Fax: 812-232-0074
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004235A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: