Individual
KYLE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
2500 N STATE ST, DEPT. OF OPHTHALMOLOGY, JACKSON, MS 39216-4500
(601) 984-5020
(601) 815-3773
Mailing address
2500 NORTH STATE STREET, JMM ROOM 2525, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
20538
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01823221
—
MS
01
—
302I188328
PTAN
MS
Enumeration date
05/24/2007
Last updated
10/08/2018
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