Healthcare Provider Details

I. General information

NPI: 1710935606
Provider Name (Legal Business Name): JOHN KEVIN LINDSAY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 FOUNTAIN GROVE DR
HIGH POINT NC
27265-8032
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 336-889-2225
  • Fax:
Mailing address:
  • Phone: 703-847-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1053
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1053
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier22-01177
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerUNITED HEALTH CARE OF NC
# 2
Identifier8909514
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier09514
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBLUE CROSS/BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: