MEDICARE: ALISA JEAN LINDLEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2662	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4137673	OTHER	TN	BLUE CROSS

General Provider Information

NPI Number	:	1790705242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA JEAN LINDLEY O.D.

Provider Business Mailing Address
First Line	:	2043 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3576
Country	:	US
Telephone Number	:	731-668-3424
Fax Number	:	731-668-3425

Provider Business Practice Location Address
First Line	:	2043 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3576
Country	:	US
Telephone Number	:	731-668-3424
Fax Number	:	731-668-3425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/12/2012

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