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General NPI Number Information
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NPI Number | 1700308988
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Entity Type | Individual
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Provider Name | MELISSA ALANE LEWIS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 07/10/2017
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Provider Practice Location Address
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Address Line | 100 S CREASY LN STE 1530
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City | LAFAYETTE
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State | IN
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Zip | 47905-0757
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Country | US
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Telephone | 765-447-5083
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Fax |
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Provider Business Mailing Address
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Address Line | 9795 CROSSPOINT BLVD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3348
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Country | US
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Telephone | 317-254-6480
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Fax | 317-259-8609
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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 | 18005040
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License Number State | IN
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