Individual
TRACEY L LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
442 W KENNEDY BLVD STE 280, TAMPA, FL 33606-1464
(813) 467-6111
(813) 467-6013
Mailing address
442 W KENNEDY BLVD STE 280, TAMPA, FL 33606-1464
(813) 906-1755
(813) 467-6013
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME109860
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GE491Z
MEDICARE PTAN
FL
01
—
K1033A
MEDICARE PTAN-GROUP
FL
Enumeration date
08/16/2005
Last updated
10/11/2021
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