Provider Demographics
NPI:1053311183
Name:LEWIS, TERRY NEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:NEAL
Last Name:LEWIS
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 1:14975 BYPASS ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8504
Mailing Address - Country:US
Mailing Address - Phone:405-390-9106
Mailing Address - Fax:405-390-1105
Practice Address - Street 1:14975 BYPASS ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8504
Practice Address - Country:US
Practice Address - Phone:405-390-9106
Practice Address - Fax:405-390-1105
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763240AMedicaid
OKU37169Medicare UPIN
OK1317550002Medicare NSC
OK$$$$$$$$$Medicare PIN