Jake Lewis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2019016593 Issued in MO

Practice address

1502 Brayton Ave
Dyersburg, TN 38024-3159

Phone

(731) 285-5411

Fax

(731) 285-8481

NPI assigned

May 29, 2019

Last updated

May 29, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jake Lewis Former name

Medicare fee-for-service enrollment

Enrolled in TN, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Southern College of Optometry, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dyersburg Family Eye CareGroup PAC ID 2163639956, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dyersburg Family Eye Care

  • Optometrist
  • Dyersburg, TN
  • NPI 1841367950
  Medicare reassignment Care Compare group NPD
• Justin Michael Schroeder, O.D.

  • Vision Therapy Optometrist
  • Caruthersville, MO
  • NPI 1215984224
  Medicare reassignment
• Bootheel Eye Care

  • Optometrist
  • Caruthersville, MO
  • NPI 1609933902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1629635354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 BRAYTON AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243159",
            "telephone_number": "731-285-5411",
            "fax_number": "731-285-8481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 BRAYTON AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243159",
            "telephone_number": "731-285-5411",
            "fax_number": "731-285-8481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "JAKE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2019016593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "LEWIS",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Marcus Legan, MD
• Regina Faye Leggett, RN
• Merrill L Lemon
• Brandi Lemons, OTR/L
• Garine Lepejian, M.D.
• Lavenda Ann Lewis
• Lifeline of West Tennessee, LLC (Extendicare Home Health of West Tennessee)
• Lifesafe LLC
• Lifesafe Security Corporation
• Lincare Inc

• Optometrist in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.