Provider Demographics
NPI:1538242888
Name:KINTNER, LINDSEY JON (OD)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:JON
Last Name:KINTNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2211
Mailing Address - Country:US
Mailing Address - Phone:574-255-1231
Mailing Address - Fax:574-255-4182
Practice Address - Street 1:517 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2211
Practice Address - Country:US
Practice Address - Phone:574-255-1231
Practice Address - Fax:574-255-4182
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002941B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000093320OtherBLUE CROSS BLUE SHIELD
IN1538242888OtherNPI
IN200169720AMedicaid
IN239740BOtherEMPLOYEE MEDICARE UPIN TO LINK HER TO DR LINDSEY
IN000000093320OtherBLUE CROSS BLUE SHIELD
IN239740BOtherEMPLOYEE MEDICARE UPIN TO LINK HER TO DR LINDSEY
IN4475710001Medicare NSC