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General NPI Number Information
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NPI Number | 1134449036
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Entity Type | Individual
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Provider Name | LINDSEY EDMUNDS O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 12/31/2017
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Provider Practice Location Address
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Address Line | 925 NW 12TH ST
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City | FRUITLAND
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State | ID
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Zip | 83619-5044
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Country | US
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Telephone | 208-452-2151
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Fax | 208-452-6508
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Provider Business Mailing Address
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Address Line | 1257 SW 4TH AVE
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City | ONTARIO
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State | OR
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Zip | 97914-4516
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Country | US
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Telephone | 541-889-2191
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Fax | 541-881-1523
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODP100212
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License Number State | ID
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