Provider Demographics
NPI:1225013980
Name:LEWIS, DOUGLAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4203
Mailing Address - Country:US
Mailing Address - Phone:512-327-7000
Mailing Address - Fax:512-314-1662
Practice Address - Street 1:1700 S MO PAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-327-7000
Practice Address - Fax:512-327-5200
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6378207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136907605Medicaid
OHTX6378OtherEYEMED
TX10014255OtherAMERIGROUP
117784100OtherFIRST CARE
TX136907601Medicaid
NY32951-005OtherDAVIS VISION
TX3356952OtherBLUELINK
TX4379838OtherAETNA
TX80363SOtherBLUE CROSS BLUE SHIELD
TX915420OtherBLOCK VISION
VP12836OtherGE WELLNESS
NY32951-005OtherDAVIS VISION
TX80363SOtherBLUE CROSS BLUE SHIELD
TX3356952OtherBLUELINK
TX136907601Medicaid
TX85022KMedicare PIN