Provider Demographics
NPI:1518116664
Name:LEWIS, AMY (DO)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1600
Mailing Address - Country:US
Mailing Address - Phone:508-376-0800
Mailing Address - Fax:508-376-2539
Practice Address - Street 1:18 MILLISTON RD
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1600
Practice Address - Country:US
Practice Address - Phone:508-376-0800
Practice Address - Fax:508-376-2539
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5940156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician