Basic Information
| Provider Information | |||||||||
| NPI: | 1740336791 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 ARNOLD MALL | ||||||||
| Address2: | |||||||||
| City: | ARNOLD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630102223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362822700 | ||||||||
| FaxNumber: | 6362823084 | ||||||||
| Practice Location | |||||||||
| Address1: | 28 ARNOLD MALL | ||||||||
| Address2: | |||||||||
| City: | ARNOLD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630102223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362822700 | ||||||||
| FaxNumber: | 6362823084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | MOTO3404 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | MA 1595008 | 01 | MO | MEDICARE ID | OTHER |