Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1225225030 |
---|---|
Provider Name | Lance B Lewis |
First Address | Fremont, CA 94538-2268 |
Second Address | Fremont, CA 94538-2268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 26/09/2007 |