Provider Demographics
NPI:1366200610
Name:LEWIS, EMILY YEH (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:YEH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:YEH
Other - Last Name:KALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 HAZARD AVE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4585
Mailing Address - Country:US
Mailing Address - Phone:860-749-1233
Mailing Address - Fax:
Practice Address - Street 1:139 HAZARD AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4585
Practice Address - Country:US
Practice Address - Phone:860-749-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist