MEDICARE: DR. LLOYD K DEWAR JR. OD

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	18001552B	IN

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	:	1184619389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LLOYD K DEWAR JR. OD

Provider Business Mailing Address
First Line	:	PO BOX 278
Second Line	:
City	:	ELLETTSVILLE
State	:	IN
Zip	:	47429-0278
Country	:	US
Telephone Number	:	812-876-6899
Fax Number	:	812-876-6809

Provider Business Practice Location Address
First Line	:	121 S 3RD ST
Second Line	:
City	:	ELLETTSVILLE
State	:	IN
Zip	:	47429-1507
Country	:	US
Telephone Number	:	812-876-6899
Fax Number	:	812-876-6809

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/23/2015

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