Individual
BETHANY M LEWALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
I3-0001251
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000989322
—
DE
01
—
1245251313
GROUP PRACTICE NPI
—
01
—
161525705
BCBSDE
DE
01
—
G00016
MEDICARE GROUP PIN
—
Enumeration date
02/17/2006
Last updated
05/03/2017
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