1427133727 NPI number — DR. HOLLY ANN LEWTON OPTOMETRIST

Table of content: (NPI 1659969004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427133727 NPI number — DR. HOLLY ANN LEWTON OPTOMETRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWTON
Provider First Name:
HOLLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OPTOMETRIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHORDAS LEWTON
Provider Other First Name:
HOLLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OPTOMETRIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427133727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6905 E 96TH ST
Provider Second Line Business Mailing Address:
1100
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-585-9800
Provider Business Mailing Address Fax Number:
317-585-9823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6905 E 96TH ST
Provider Second Line Business Practice Location Address:
1100
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-585-9800
Provider Business Practice Location Address Fax Number:
317-585-9823
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18002745A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6551 . This is a "DAVIS VISION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 184697 . This is a "EYE MED" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 15380 . This is a "SPECTRA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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