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General NPI Number Information
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NPI Number | 1386873180
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Entity Type | Individual
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Provider Name | WESLEY DEWAYNE LEWIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 1303 DR MARTIN L KING JR AVE
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City | MOBILE
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State | AL
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Zip | 36603-5341
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Country | US
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Telephone | 251-666-5060
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Fax | 251-666-5789
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Provider Business Mailing Address
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Address Line | 3187 CORNELL DR STE 201
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City | GULF BREEZE
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State | FL
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Zip | 32563-2785
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Country | US
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Telephone | 228-731-7417
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Fax | 636-527-0766
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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 | 944TPA94515
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | R-251-TA-A69
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License Number State | AL
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