Healthcare Provider Details

I. General information

NPI: 1134130313
Provider Name (Legal Business Name): FELICIA JOLIE LEW O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3088 TELEGRAPH RD SUITE A
VENTURA CA
93003-3234
US

IV. Provider business mailing address

3088 TELEGRAPH RD SUITE A
VENTURA CA
93003-3234
US

V. Phone/Fax

Practice location:
  • Phone: 805-648-6891
  • Fax:
Mailing address:
  • Phone: 805-648-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: