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General NPI Number Information
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NPI Number | 1952301095
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Entity Type | Individual
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Provider Name | LARRY JOE LEWIS O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 14975 BYPASS ST
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City | CHOCTAW
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State | OK
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Zip | 73020-8504
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Country | US
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Telephone | 405-390-9106
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Fax | 405-390-1105
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Provider Business Mailing Address
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Address Line | 14975 BYPASS ST
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City | CHOCTAW
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State | OK
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Zip | 73020-8504
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Country | US
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Telephone | 405-390-9106
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Fax | 405-390-1105
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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 | 768
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License Number State | OK
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