Provider Demographics
NPI:1003801473
Name:LEWIS, DAVID SIDNEY (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SIDNEY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3928 MONTCLAIR RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2426
Mailing Address - Country:US
Mailing Address - Phone:205-592-3911
Mailing Address - Fax:
Practice Address - Street 1:7067 VETERANS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-5128
Practice Address - Country:US
Practice Address - Phone:205-592-3911
Practice Address - Fax:205-460-8238
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL00027609207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009939813Medicaid
AL510-04377OtherBCBSAL
AL510-04377OtherBCBSAL
AL051558438Medicare PIN
AL0132340001Medicare NSC