Provider Demographics
NPI:1942261789
Name:LEWIS, JEFFREY (OD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
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 1:940 N TANQUE VERDE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-3828
Mailing Address - Country:US
Mailing Address - Phone:520-745-0770
Mailing Address - Fax:520-745-2392
Practice Address - Street 1:5870 E BROADWAY BLVD
Practice Address - Street 2:STE302
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3914
Practice Address - Country:US
Practice Address - Phone:520-745-0770
Practice Address - Fax:520-745-2392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0891152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ66536Medicare ID - Type Unspecified
AZU86188Medicare UPIN