Healthcare Provider Details

I. General information

NPI: 1265444293
Provider Name (Legal Business Name): RENA C LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 HIGHWAY 31 S
PELHAM AL
35124-1322
US

IV. Provider business mailing address

2617 HIGHWAY 31 S
PELHAM AL
35124-1322
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-1575
  • Fax:
Mailing address:
  • Phone: 205-664-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberS599TA190
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: