Healthcare Provider Details

I. General information

NPI: 1497147680
Provider Name (Legal Business Name): JOSEPH LEWIS LICHT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 BROWNWOOD BLVD STE 303
THE VILLAGES FL
32163-2040
US

IV. Provider business mailing address

3252 MAGNOLIA LANDING LN
NORTH FORT MYERS FL
33917-7807
US

V. Phone/Fax

Practice location:
  • Phone: 352-350-8484
  • Fax: 352-751-9850
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberOS16173
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS16173
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS16173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: