Basic Information
| Provider Information | |||||||||
| NPI: | 1952608382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26222 RANCH ROAD 12 | ||||||||
| Address2: | |||||||||
| City: | DRIPPING SPRINGS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786204903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128580300 | ||||||||
| FaxNumber: | 5128582714 | ||||||||
| Practice Location | |||||||||
| Address1: | 15577 SW 116TH AVE | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972242653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039686445 | ||||||||
| FaxNumber: | 5039688968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2011 | ||||||||
| LastUpdateDate: | 03/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAS-P-127970 | OR | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.