MEDICARE: TODD F LEWIS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1184DT	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013901180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD F LEWIS O.D.

Provider Business Mailing Address
First Line	:	5338 S 3RD ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-2675
Country	:	US
Telephone Number	:	502-366-4530
Fax Number	:	502-366-4590

Provider Business Practice Location Address
First Line	:	5338 S 3RD ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-2675
Country	:	US
Telephone Number	:	502-366-4530
Fax Number	:	502-366-4590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	10/01/2013

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