Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1522 | AZ |
N | 152W00000X | Optometrist | 2497 | CO |
N | 152WP0200X | Pediatric Optomitrist | 1522 | AZ |
N | 152WP0200X | Pediatric Optomitrist | 2497 | CO |
N | 152WS0006X | Sports Vision | 1522 | AZ |
N | 152WS0006X | Sports Vision | 2497 | CO |
N | 156FC0801X | Contact Lens Fitter | 1522 | AZ |
NPI | 1427018282 |
---|---|
Provider Name | Dr. Lindsey Michelle Clyde |
First Address | Phoenix, AZ 85020-4188 |
Second Address | Phoenix, AZ 85020-4188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 02/07/2014 |