Provider Demographics
NPI:1932305273
Name:LEW, JULIE C (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:LEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-589-3100
Mailing Address - Fax:740-589-3151
Practice Address - Street 1:2131 EAST STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-589-3100
Practice Address - Fax:740-566-4013
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV24226207W00000X
OH35.092596207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000263285OtherOHIO MEDICAID UNISON
WV3810015008Medicaid
OH2963584Medicaid
OH310917085212OtherOHIO MEDICAID CARESOURCE
P00810142OtherRAILROAD MEDICARE
OH2963584OtherOH MEDICAID MOLINA
OH2963584OtherOH MEDICAID MOLINA