Provider Demographics
NPI:1891338737
Name:FELICIA J LEW, OD, OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:FELICIA J LEW, OD, OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-765-4892
Mailing Address - Street 1:3160 TELEGRAPH RD STE 206
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3257
Mailing Address - Country:US
Mailing Address - Phone:805-765-4892
Mailing Address - Fax:
Practice Address - Street 1:3160 TELEGRAPH RD STE 206
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3257
Practice Address - Country:US
Practice Address - Phone:805-765-4892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty