Provider Demographics
NPI:1649305616
Name:LEWIS, ROBIN (OD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
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 1:2950 N DOBSON RD STE 11
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1824
Mailing Address - Country:US
Mailing Address - Phone:480-963-8833
Mailing Address - Fax:480-963-3766
Practice Address - Street 1:2950 N DOBSON RD STE 11
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1824
Practice Address - Country:US
Practice Address - Phone:480-963-8833
Practice Address - Fax:480-963-3766
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ485152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
T88153Medicare UPIN