MEDICARE: CRYSTAL TINA LEW 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	13966	CA

General Provider Information

NPI Number	:	1548574569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL TINA LEW O.D.

Provider Business Mailing Address
First Line	:	1418 POLK ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 POLK ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4616
Country	:	US
Telephone Number	:	415-776-5872
Fax Number	:

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

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	01/03/2022

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