MEDICARE: LEWIS B KIZER

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	762	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN1164	OTHER	TN	PALMETTO GBA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558565168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS B KIZER

Provider Business Mailing Address
First Line	:	PO BOX 548
Second Line	:
City	:	MILAN
State	:	TN
Zip	:	38358-0548
Country	:	US
Telephone Number	:	731-686-8642
Fax Number	:	731-686-7622

Provider Business Practice Location Address
First Line	:	2081 SOUTH MAIN ST
Second Line	:
City	:	MILAN
State	:	TN
Zip	:	38358-3011
Country	:	US
Telephone Number	:	731-686-8642
Fax Number	:	731-686-7622

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEWIS BOND KIZER
Credential	:	OD
Telephone Number	:	731-686-8642

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	08/09/2023

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Directions to “LEWIS B KIZER ” Practice Location

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