Provider Demographics
NPI:1558565168
Name:LEWIS B KIZER
Entity Type:Organization
Organization Name:LEWIS B KIZER
Other - Org Name:LEWIS B KIZER OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:BOND
Authorized Official - Last Name:KIZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-686-8642
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-0548
Mailing Address - Country:US
Mailing Address - Phone:731-686-8642
Mailing Address - Fax:731-686-7622
Practice Address - Street 1:2081 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3011
Practice Address - Country:US
Practice Address - Phone:731-686-8642
Practice Address - Fax:731-686-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDN1164OtherPALMETTO GBA
TN3594690Medicaid
TN3726103Medicaid
TNY18360Medicare UPIN
TN4748380001Medicare NSC