Provider Demographics
NPI:1285626291
Name:LEWIS, TRACEY L (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:442 W KENNEDY BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1464
Mailing Address - Country:US
Mailing Address - Phone:813-906-1755
Mailing Address - Fax:813-467-6013
Practice Address - Street 1:442 W KENNEDY BLVD STE 280
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1464
Practice Address - Country:US
Practice Address - Phone:813-467-6111
Practice Address - Fax:813-467-6013
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME109860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGE491ZOtherMEDICARE PTAN
FLK1033AOtherMEDICARE PTAN-GROUP