Provider Demographics
NPI:1417943325
Name:LEWIS, JENNA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16706 CHILLICOTHE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4573
Mailing Address - Country:US
Mailing Address - Phone:440-708-0020
Mailing Address - Fax:440-708-0302
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:306
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-292-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV01889Medicare UPIN