1548483100 NPI number — LEWIS & LEWIS EYE CARE CLINIC, P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548483100 NPI number — LEWIS & LEWIS EYE CARE CLINIC, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS & LEWIS EYE CARE CLINIC, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1548483100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14975 BYPASS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHOCTAW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73020-8504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-390-9106
Provider Business Mailing Address Fax Number:
405-390-1105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14975 BYPASS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHOCTAW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73020-8504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-390-9106
Provider Business Practice Location Address Fax Number:
405-390-1105
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
NEAL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-390-9106

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2072 AND 768 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1053311183 . This is a "TERRY LEWIS NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 456607937001 . This is a "LARRY LEWIS BLUE CROSS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100766570A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 443703087 . This is a "TERRY LEWIS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1317550002 . This is a "PALMETTO GBA DMERC" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1952301095 . This is a "LARRY LEWIS NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 443703087001 . This is a "TERRY LEWIS BLUE CROSS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 456607937 . This is a "LARRY LEWIS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 700522004 . This is a "MEDICARE PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100763240A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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