Provider Demographics
NPI:1013107259
Name:LEWISVILLE OPTICAL INC
Entity Type:Organization
Organization Name:LEWISVILLE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SIPE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-945-3716
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0399
Mailing Address - Country:US
Mailing Address - Phone:336-945-3716
Mailing Address - Fax:336-945-3001
Practice Address - Street 1:6758 SHALLOWFORD ROAD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023
Practice Address - Country:US
Practice Address - Phone:336-945-3716
Practice Address - Fax:336-945-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC881332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC246213BMedicare PIN
NC0607800001Medicare NSC
NCT64765Medicare UPIN