Provider Demographics
NPI:1962029587
Name:LEWIS, MACI (OD)
Entity Type:Individual
Prefix:DR
First Name:MACI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3865
Mailing Address - Country:US
Mailing Address - Phone:501-941-2222
Mailing Address - Fax:501-941-2577
Practice Address - Street 1:1004 S PINE ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3865
Practice Address - Country:US
Practice Address - Phone:501-941-2222
Practice Address - Fax:501-941-2577
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2811OtherARKANSAS STATE OPTOMETRY LICENSE