Healthcare Provider Details

I. General information

NPI: 1871944793
Provider Name (Legal Business Name): LINDSEY ADAMS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 01/29/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 VILLAGE CENTER BLVD
MYRTLE BEACH SC
29579
US

IV. Provider business mailing address

150 VILLAGE CENTER BLVD
MYRTLE BEACH SC
29579
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-7115
  • Fax:
Mailing address:
  • Phone: 843-449-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2449
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2744
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3517
License Number StateTN

VII. Legacy identifiers

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

# 1
Identifier05059061
Identifier TypeMEDICAID
Identifier StateMS
Identifier Issuer
# 2
IdentifierQ051584
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: