Provider Demographics
NPI:1497881023
Name:LEWIS, SIMONE GINA (OD)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:GINA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9765 ROD RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7563
Mailing Address - Country:US
Mailing Address - Phone:678-557-6727
Mailing Address - Fax:
Practice Address - Street 1:5165 PEACHTREE PKWY
Practice Address - Street 2:SUITE 225
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2523
Practice Address - Country:US
Practice Address - Phone:770-447-4790
Practice Address - Fax:770-447-4368
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA001584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist