Provider Demographics
NPI:1407022643
Name:LEWIS, HARRY ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ROBERT
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 1:2825 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-3603
Mailing Address - Country:US
Mailing Address - Phone:323-373-9633
Mailing Address - Fax:323-373-9844
Practice Address - Street 1:2825 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-3603
Practice Address - Country:US
Practice Address - Phone:323-373-9633
Practice Address - Fax:323-373-9844
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5174T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist