Individual
STEPHEN CHARLES LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1901 W PARKWAY BLVD, SALT LAKE CITY, UT 84119
(801) 886-2020
(801) 954-0054
Mailing address
1901 W PARKWAY BLVD, SALT LAKE CITY, UT 84119
(801) 886-2020
(801) 954-0054
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1108139934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000004481
MEDICARE STORE #5 PTAN
UT
01
—
000009841
MEDICARE STORE #13 PTAN
UT
01
—
87017934007001
BC/BS
UT
01
—
87017934024001
BC/BS
UT
05
—
999000797009
—
UT
Enumeration date
07/03/2006
Last updated
05/23/2008
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