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NPI Code Detail

MEDICARE: CELESTE LEWIS O.D.

MEDICARE: CELESTE 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
1152W00000XOptometrist0618000228VA

General Provider Information

NPI Number : 1457312159
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELESTE LEWIS O.D.
Provider Business Mailing Address
First Line : 2324 WOODHURST LN
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23322-3140
Country : US
Telephone Number : 757-560-2794
Fax Number :
Provider Business Practice Location Address
First Line : 226 FORT LN
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23704-2220
Country : US
Telephone Number : 757-393-0976
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 05/04/2017

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