Provider Demographics
NPI:1952312878
Name:LEWINSON, DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:LEWINSON
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 1:2 W GRAND AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1262
Mailing Address - Country:US
Mailing Address - Phone:847-587-0901
Mailing Address - Fax:847-587-8157
Practice Address - Street 1:2 W GRAND AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1262
Practice Address - Country:US
Practice Address - Phone:847-587-0901
Practice Address - Fax:847-587-8157
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT95270Medicare UPIN
728530Medicare PIN