Provider Demographics
NPI:1053458539
Name:DR. MARION S. LEWIS & ASSOCIATES
Entity type:Organization
Organization Name:DR. MARION S. LEWIS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:863-648-4770
Mailing Address - Street 1:5535 KINGS MONT DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3280
Mailing Address - Country:US
Mailing Address - Phone:863-648-4770
Mailing Address - Fax:888-873-4425
Practice Address - Street 1:5535 KINGS MONT DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3280
Practice Address - Country:US
Practice Address - Phone:863-648-4770
Practice Address - Fax:888-873-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1235152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K0941Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER