Individual
MR. LARRY S LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
790 CONCOURSE PKWY S, SUITE 200, MAITLAND, FL 32751-6114
(407) 767-6411
(407) 767-8160
Mailing address
1033 DR MARTIN LUTHER KING JR ST N, SUITE 108, ST PETERSBURG, FL 33701-1547
(727) 322-7920
(727) 322-7921
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC2190
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078800700
—
FL
Enumeration date
06/03/2006
Last updated
02/25/2014
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