Provider Demographics
NPI:1265426977
Name:ANDERSON LINDSAY, ANGELA L (OD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:L
Last Name:ANDERSON LINDSAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4537
Mailing Address - Country:US
Mailing Address - Phone:863-299-8908
Mailing Address - Fax:863-299-1061
Practice Address - Street 1:2315 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9525
Practice Address - Country:US
Practice Address - Phone:863-212-7070
Practice Address - Fax:863-238-1640
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103628600Medicaid
FL620861400Medicaid
U97981Medicare UPIN
FLU1636ZMedicare PIN