1427133727 NPI number — DR. HOLLY ANN LEWTON OPTOMETRIST

Table of content: DR. HOLLY ANN LEWTON OPTOMETRIST (NPI 1427133727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427133727 NPI number — DR. HOLLY ANN LEWTON OPTOMETRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWTON
Provider First Name:
HOLLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OPTOMETRIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHORDAS LEWTON
Provider Other First Name:
HOLLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OPTOMETRIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427133727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6905 E 96TH ST
Provider Second Line Business Mailing Address:
1100
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-585-9800
Provider Business Mailing Address Fax Number:
317-585-9823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6905 E 96TH ST
Provider Second Line Business Practice Location Address:
1100
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-585-9800
Provider Business Practice Location Address Fax Number:
317-585-9823
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18002745A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6551 . This is a "DAVIS VISION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 184697 . This is a "EYE MED" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 15380 . This is a "SPECTRA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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