Basic Information
| Provider Information | |||||||||
| NPI: | 1386681351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | LINDY | ||||||||
| MiddleName: | HATFIELD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 509 | ||||||||
| Address2: | |||||||||
| City: | HUMBOLDT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383430509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316683018 | ||||||||
| FaxNumber: | 7316689158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000A VANN DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383056001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316683018 | ||||||||
| FaxNumber: | 7316689158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 01/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OD1607 | TN | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 9861183 | 01 | CIGNA HEALTHCARE | OTHER | 3943221 | 05 | TN | MEDICAID | 9810 | 01 | TN | TLC MEMPHIS MANAGED CARE | OTHER | 4105789 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |