MEDICARE: DR. BRIAN JON LEWY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618002616	VA
2	152W00000X	Optometrist	21447-875	WI
3	152W00000X	Optometrist	4901005040	MI
4	152W00000X	Optometrist	OPT.0003325	CO
5	152W00000X	Optometrist	3016	CT
6	152W00000X	Optometrist	3500	MN
7	152W00000X	Optometrist	TPOP61	FL
8	152W00000X	Optometrist	DA2597	MD
9	152W00000X	Optometrist	VUT4433	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VUT4433	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1750379087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JON LEWY OD

Provider Business Mailing Address
First Line	:	30 REGENT DR
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-4923
Country	:	US
Telephone Number	:	212-752-1212
Fax Number	:	212-752-8507

Provider Business Practice Location Address
First Line	:	16 E 52ND ST
Second Line	:	STE 500
City	:	NEW YORK
State	:	NY
Zip	:	10022-5306
Country	:	US
Telephone Number	:	212-752-1212
Fax Number	:	212-752-8507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	02/17/2023

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Directions to “ DR. BRIAN JON LEWY OD” Practice Location

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