Provider Demographics
NPI:1013901180
Name:LEWIS, TODD F (OD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:F
Last Name:LEWIS
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 1:5338 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2675
Mailing Address - Country:US
Mailing Address - Phone:502-366-4530
Mailing Address - Fax:502-366-4590
Practice Address - Street 1:5338 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2675
Practice Address - Country:US
Practice Address - Phone:502-366-4530
Practice Address - Fax:502-366-4590
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1184DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011849Medicaid
KYU28319Medicare UPIN
KY77011849Medicaid