Provider Demographics
NPI:1558381657
Name:CUTTER, LEWIS MOORE (OD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:MOORE
Last Name:CUTTER
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:PO BOX 880308
Mailing Address - Street 2:STE 120
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-0308
Mailing Address - Country:US
Mailing Address - Phone:970-879-2595
Mailing Address - Fax:970-879-8337
Practice Address - Street 1:1755 CENTRAL PARK DRIVE
Practice Address - Street 2:STE 120
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-0308
Practice Address - Country:US
Practice Address - Phone:970-879-2595
Practice Address - Fax:970-879-8337
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1398OtherOPTOMETRY LICENSE#
CO4077560001OtherSUPPLIER # CIGNA MEDICARE
CO1398OtherOPTOMETRY LICENSE#
CO4077560001OtherSUPPLIER # CIGNA MEDICARE