Provider Demographics
NPI:1225225030
Name:LEWIS, LANCE B
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 KEARNEY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2268
Mailing Address - Country:US
Mailing Address - Phone:510-490-6400
Mailing Address - Fax:
Practice Address - Street 1:3155 KEARNEY ST STE 130
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2268
Practice Address - Country:US
Practice Address - Phone:510-490-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter