MEDICARE: DR. MELISSA R 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
1	152W00000X	Optometrist	MOTO3404	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA 1595008	OTHER	MO	MEDICARE ID

General Provider Information

NPI Number	:	1740336791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA R LEWIS O.D.

Provider Business Mailing Address
First Line	:	28 ARNOLD MALL
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2223
Country	:	US
Telephone Number	:	636-282-2700
Fax Number	:	636-282-3084

Provider Business Practice Location Address
First Line	:	28 ARNOLD MALL
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2223
Country	:	US
Telephone Number	:	636-282-2700
Fax Number	:	636-282-3084

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	09/17/2013

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