Healthcare Provider Details

I. General information

NPI: 1720737679
Provider Name (Legal Business Name): ADAM L LEWIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 W GROVE PKWY STE 300
PLEASANT GROVE UT
84062-6729
US

IV. Provider business mailing address

1972 W GROVE PKWY STE 300
PLEASANT GROVE UT
84062-6729
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-0494
  • Fax: 801-221-1052
Mailing address:
  • Phone: 801-224-6767
  • Fax: 801-221-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14284164-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: