Provider Demographics
NPI:1972698462
Name:LEWIS, TAMARA
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:800 TRANCAS ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-9455
Mailing Address - Country:US
Mailing Address - Phone:707-255-6212
Mailing Address - Fax:707-255-6290
Practice Address - Street 1:800 TRANCAS ST.
Practice Address - Street 2:SUITE A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-9455
Practice Address - Country:US
Practice Address - Phone:707-255-6212
Practice Address - Fax:707-255-6290
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10088 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist