Provider Demographics
NPI:1538379011
Name:LINLEY, PRESTON G (OD)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:G
Last Name:LINLEY
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 1:5700 MONROE ST
Mailing Address - Street 2:SUITE 211 PROMEDICA HEALTH AND WELLNESS CENTER
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:866-935-5393
Mailing Address - Fax:734-243-3236
Practice Address - Street 1:5700 MONROE ST
Practice Address - Street 2:SUITE 211 PROMEDICA HEALTH AND WELLNESS CENTER
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:866-935-5393
Practice Address - Fax:734-243-3236
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5688152W00000X
MI4901004510152W00000X
OHOPT5688THER152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2759260Medicaid
OH4210001Medicare PIN
OH4210004Medicare PIN
OH4210002Medicare PIN
OH4210006Medicare PIN
OH4210003Medicare PIN
OH4210005Medicare PIN