Provider Demographics
NPI:1710084447
Name:KANNWISCHER, LEWIS RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:RICHARD
Last Name:KANNWISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3115 PINE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3247
Mailing Address - Country:US
Mailing Address - Phone:254-752-8328
Mailing Address - Fax:254-752-7724
Practice Address - Street 1:3115 PINE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3247
Practice Address - Country:US
Practice Address - Phone:254-752-8328
Practice Address - Fax:254-752-7724
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5055207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC17690Medicare UPIN