Provider Demographics
NPI:1174923189
Name:KLUMPP, LINDSAY KATHARINE (OD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:KATHARINE
Last Name:KLUMPP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:KATHARINE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:850 W NORTH ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3196
Mailing Address - Country:US
Mailing Address - Phone:877-852-8463
Mailing Address - Fax:
Practice Address - Street 1:850 W NORTH ST
Practice Address - Street 2:STE. 100
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3196
Practice Address - Country:US
Practice Address - Phone:877-852-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist