Provider Demographics
NPI:1427133727
Name:LEWTON, HOLLY ANN (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:LEWTON
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:CHORDAS LEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OPTOMETRIST
Mailing Address - Street 1:6905 E 96TH ST
Mailing Address - Street 2:1100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3302
Mailing Address - Country:US
Mailing Address - Phone:317-585-9800
Mailing Address - Fax:317-585-9823
Practice Address - Street 1:6905 E 96TH ST
Practice Address - Street 2:1100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3302
Practice Address - Country:US
Practice Address - Phone:317-585-9800
Practice Address - Fax:317-585-9823
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002745A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6551OtherDAVIS VISION
IN184697OtherEYE MED
IN15380OtherSPECTRA
201290Medicare ID - Type Unspecified
IN6551OtherDAVIS VISION