Provider Demographics
NPI:1942485669
Name:JEFFREY LEWIS OD
Entity Type:Organization
Organization Name:JEFFREY LEWIS OD
Other - Org Name:ORINDA OPTOMETRIC VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-254-5914
Mailing Address - Street 1:81 MORAGA WAY
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563
Mailing Address - Country:US
Mailing Address - Phone:925-254-5914
Mailing Address - Fax:925-254-8919
Practice Address - Street 1:81 MORAGA WAY
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563
Practice Address - Country:US
Practice Address - Phone:925-254-5914
Practice Address - Fax:925-254-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11075T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84348Medicare UPIN
CA4955670001Medicare NSC
CASD0110750Medicare PIN