Provider Demographics
NPI:1053588095
Name:LEWIS, JAMES S
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ASYLUM ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2208
Mailing Address - Country:US
Mailing Address - Phone:860-522-2020
Mailing Address - Fax:860-522-5577
Practice Address - Street 1:45 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2208
Practice Address - Country:US
Practice Address - Phone:860-522-2020
Practice Address - Fax:860-522-5577
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1498156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician