Provider Demographics
NPI:1154412534
Name:LEWIS, RAMONICA (OD)
Entity type:Individual
Prefix:
First Name:RAMONICA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 DEVLIN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6549
Mailing Address - Country:US
Mailing Address - Phone:601-278-1445
Mailing Address - Fax:
Practice Address - Street 1:950 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5203
Practice Address - Country:US
Practice Address - Phone:601-924-7882
Practice Address - Fax:601-924-7883
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00237390Medicaid