Provider Demographics
NPI:1386681351
Name:LEWIS, LINDY HATFIELD (O D)
Entity type:Individual
Prefix:DR
First Name:LINDY
Middle Name:HATFIELD
Last Name:LEWIS
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-0509
Mailing Address - Country:US
Mailing Address - Phone:731-668-3018
Mailing Address - Fax:731-668-9158
Practice Address - Street 1:1000A VANN DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6001
Practice Address - Country:US
Practice Address - Phone:731-668-3018
Practice Address - Fax:731-668-9158
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9861183OtherCIGNA HEALTHCARE
TN3943221Medicaid
TN9810OtherTLC MEMPHIS MANAGED CARE
TN4105789OtherBLUE CROSS BLUE SHIELD
TN3943221Medicare PIN
U54179Medicare UPIN
TNP00223483Medicare PIN