Healthcare Provider Details

I. General information

NPI: 1932182920
Provider Name (Legal Business Name): RODGER V LEWIS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N MAIN ST
LAS CRUCES NM
88001-1119
US

IV. Provider business mailing address

PO BOX 340
LAS CRUCES NM
88004-0340
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-4351
  • Fax: 575-524-8159
Mailing address:
  • Phone: 575-524-4351
  • Fax: 575-524-8159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0232
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: