Provider Demographics
NPI:1174500789
Name:LEWIS, ALAN K (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:K
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 1:6748 RACCOON RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MO
Mailing Address - Zip Code:64844-7111
Mailing Address - Country:US
Mailing Address - Phone:417-389-0665
Mailing Address - Fax:417-358-3649
Practice Address - Street 1:2705 GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836
Practice Address - Country:US
Practice Address - Phone:417-358-1203
Practice Address - Fax:417-358-3649
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000026122Medicare PIN