MEDICARE: LEWIS OPTICAL, INC

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	332H00000X	Eyewear Supplier	17181321	MO

General Provider Information

NPI Number	:	1659379568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS OPTICAL, INC

Provider Business Mailing Address
First Line	:	825 S MAIDEN LN
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64801-3803
Country	:	US
Telephone Number	:	417-781-6644
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 S MAIDEN LN
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64801-3803
Country	:	US
Telephone Number	:	417-781-6644
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN D LEWIS
Credential	:
Telephone Number	:	417-781-6644

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/22/2020

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