Healthcare Provider Details

I. General information

NPI: 1629994736
Provider Name (Legal Business Name): CAITLIN LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S CLARIZZ BLVD
BLOOMINGTON IN
47401-5517
US

IV. Provider business mailing address

415 S CLARIZZ BLVD
BLOOMINGTON IN
47401-5517
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-1911
  • Fax:
Mailing address:
  • Phone: 812-333-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004688A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: