Healthcare Provider Details

I. General information

NPI: 1922363589
Provider Name (Legal Business Name): LYNDSAY LEIGH OLMSTEAD O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNDSAY LEIGH TOMKINS O.D.

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 SPRING STREET UNIT 101
PETOSKEY MI
49770
US

IV. Provider business mailing address

932 SPRING STREET UNIT 101
PETOSKEY MI
49770
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-5315
  • Fax: 231-487-5316
Mailing address:
  • Phone: 231-487-5315
  • Fax: 231-487-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004701
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4901004701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: