Provider Demographics
NPI:1437142973
Name:LEWIS, LUIS C (OD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:C
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 1:329 W 18TH ST STE 311
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5132
Mailing Address - Country:US
Mailing Address - Phone:312-929-3340
Mailing Address - Fax:312-929-3341
Practice Address - Street 1:329 W 18TH ST
Practice Address - Street 2:#311
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1120
Practice Address - Country:US
Practice Address - Phone:312-929-3340
Practice Address - Fax:312-929-3341
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009794Medicaid
IL046009794Medicaid
V06285Medicare UPIN