Provider Demographics
NPI:1619538956
Name:LEWIS, TIERA
Entity Type:Individual
Prefix:MRS
First Name:TIERA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TIERA
Other - Middle Name:
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 RIVELY AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1119
Mailing Address - Country:US
Mailing Address - Phone:445-800-5005
Mailing Address - Fax:610-534-1080
Practice Address - Street 1:708 RIVELY AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1119
Practice Address - Country:US
Practice Address - Phone:445-800-5005
Practice Address - Fax:610-534-1080
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier