MEDICARE: TRACEY L LEWIS MD

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	207W00000X	Ophthalmology Physician	ME109860	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GE491Z	OTHER	FL	MEDICARE PTAN
2	K1033A	OTHER	FL	MEDICARE PTAN-GROUP

Other Identifiers

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

General Provider Information

NPI Number	:	1285626291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY L LEWIS MD

Provider Business Mailing Address
First Line	:	442 W KENNEDY BLVD STE 280
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1464
Country	:	US
Telephone Number	:	813-906-1755
Fax Number	:	813-467-6013

Provider Business Practice Location Address
First Line	:	442 W KENNEDY BLVD STE 280
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1464
Country	:	US
Telephone Number	:	813-467-6111
Fax Number	:	813-467-6013

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	10/11/2021

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