Provider Demographics
NPI:1366593543
Name:LEWIS, JEFFREY ADAM (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ADAM
Last Name:LEWIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MORAGA WAY
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3023
Mailing Address - Country:US
Mailing Address - Phone:925-254-5914
Mailing Address - Fax:925-254-8919
Practice Address - Street 1:81 MORAGA WAY
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3023
Practice Address - Country:US
Practice Address - Phone:925-254-5914
Practice Address - Fax:925-254-8919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84348Medicare ID - Type Unspecified
F11521Medicare UPIN