Healthcare Provider Details

I. General information

NPI: 1013107259
Provider Name (Legal Business Name): LEWISVILLE OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6758 SHALLOWFORD ROAD
LEWISVILLE NC
27023
US

IV. Provider business mailing address

PO BOX 399
LEWISVILLE NC
27023-0399
US

V. Phone/Fax

Practice location:
  • Phone: 336-945-3716
  • Fax: 336-945-3001
Mailing address:
  • Phone: 336-945-3716
  • Fax: 336-945-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number881
License Number StateNC

VIII. Authorized Official

Name: DR. RICKEY LEE SIPE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 336-945-3716