1225013980 NPI number — DR. DOUGLAS E LEWIS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225013980 NPI number — DR. DOUGLAS E LEWIS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LEWIS

Provider First Name:

DOUGLAS

Provider Middle Name:

E

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1225013980

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/03/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5717 BALCONES DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

AUSTIN

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

78731-4203

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

512-327-7000

Provider Business Mailing Address Fax Number:

512-314-1662

Provider First Line Business Practice Location Address:

1700 S MO PAC EXPY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

AUSTIN

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

78746

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

512-327-7000

Provider Business Practice Location Address Fax Number:

512-327-5200

Provider Enumeration Date:

12/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  H6378 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 136907605 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: TX6378 . This is a "EYEMED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 10014255 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 117784100 . This is a "FIRST CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 136907601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 32951-005 . This is a "DAVIS VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 3356952 . This is a "BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 4379838 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 80363S . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 915420 . This is a "BLOCK VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: VP12836 . This is a "GE WELLNESS" identifier . This identifiers is of the category "OTHER".