Provider Demographics
NPI:1457791998
Name:LEWIS, JOSHUA ORR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ORR
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:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:OVERGAARD
Mailing Address - State:AZ
Mailing Address - Zip Code:85933-0969
Mailing Address - Country:US
Mailing Address - Phone:928-535-6667
Mailing Address - Fax:928-535-5561
Practice Address - Street 1:1951 S WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE 1001
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7322
Practice Address - Country:US
Practice Address - Phone:928-535-6667
Practice Address - Fax:928-535-5561
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ903521Medicaid