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General NPI Number Information
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NPI Number | 1124597307
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Entity Type | Individual
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Provider Name | DAKOTA RHEA LEWIS OD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 883 E BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-8113
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Country | US
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Telephone | 813-661-1930
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Fax |
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Provider Business Mailing Address
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Address Line | 2907 LAUREL MEADOW CT
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City | PLANT CITY
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State | FL
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Zip | 33566-0386
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Country | US
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Telephone | 813-895-9389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5607
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License Number State | FL
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