Healthcare Provider Details

I. General information

NPI: 1841235959
Provider Name (Legal Business Name): LUCAS LINDSELL M.D., O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DR
BLUE ASH OH
45242-5664
US

IV. Provider business mailing address

1945 CEI DR
BLUE ASH OH
45242-5664
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-3741
  • Fax:
Mailing address:
  • Phone: 513-569-3741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35128011
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: