Provider Demographics
NPI:1437126422
Name:LEBOW, JOSEPH E (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:LEBOW
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 1:221 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2809
Mailing Address - Country:US
Mailing Address - Phone:804-458-5819
Mailing Address - Fax:804-458-4580
Practice Address - Street 1:221 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2809
Practice Address - Country:US
Practice Address - Phone:804-458-5819
Practice Address - Fax:804-458-4580
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010056411Medicaid
VA00V843L88Medicare ID - Type Unspecified
5157010001Medicare NSC
VA010056411Medicaid