Provider Demographics
NPI:1730110354
Name:LEWIS, E. WINTER (OD)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:WINTER
Last Name:LEWIS
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 1:2450 NE MARY ROSE PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7132
Mailing Address - Country:US
Mailing Address - Phone:541-318-8388
Mailing Address - Fax:541-318-7145
Practice Address - Street 1:2450 NE MARY ROSE PL
Practice Address - Street 2:SUITE 110
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7132
Practice Address - Country:US
Practice Address - Phone:541-318-8388
Practice Address - Fax:541-318-7145
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2786ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228967Medicaid
ORU85973Medicare UPIN
OR115218Medicare ID - Type Unspecified