Provider Demographics
NPI:1336643741
Name:LEMOS, ELIZABETH (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:LEMOS
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:REICHMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2656 QUARRY PT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3692
Mailing Address - Country:US
Mailing Address - Phone:913-205-8917
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:913-205-8917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH006653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty