Provider Demographics
NPI:1750379087
Name:LEWY, BRIAN JON (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JON
Last Name:LEWY
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 1:30 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4923
Mailing Address - Country:US
Mailing Address - Phone:212-752-1212
Mailing Address - Fax:212-752-8507
Practice Address - Street 1:16 E 52ND ST
Practice Address - Street 2:STE 500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5306
Practice Address - Country:US
Practice Address - Phone:212-752-1212
Practice Address - Fax:212-752-8507
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002616152W00000X
WI21447-875152W00000X
MI4901005040152W00000X
COOPT.0003325152W00000X
CT3016152W00000X
MN3500152W00000X
FLTPOP61152W00000X
MDDA2597152W00000X
NYVUT4433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVUT4433OtherLICENSE
NYC31741Medicare ID - Type Unspecified
NYVUT4433OtherLICENSE