Provider Demographics
NPI:1700177490
Name:DR HOLLY LEWTON PC
Entity Type:Organization
Organization Name:DR HOLLY LEWTON PC
Other - Org Name:DR. LEWTON AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-585-9824
Mailing Address - Street 1:6905 E 96TH ST
Mailing Address - Street 2:SUITE #1100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4448
Mailing Address - Country:US
Mailing Address - Phone:317-576-9809
Mailing Address - Fax:317-585-9823
Practice Address - Street 1:6905 E 96TH ST
Practice Address - Street 2:SUITE #1100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4448
Practice Address - Country:US
Practice Address - Phone:317-576-9809
Practice Address - Fax:317-585-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002745152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427133727OtherNPI TYPE 1