Provider Demographics
NPI:1548351760
Name:LEWIS, DOUGLAS AUGUSTUS (PHD, AUD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:AUGUSTUS
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6639 BARONSCOURT LOOP
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6090
Mailing Address - Country:US
Mailing Address - Phone:740-438-2791
Mailing Address - Fax:614-389-2290
Practice Address - Street 1:6639 BARONSCOURT LOOP
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-6090
Practice Address - Country:US
Practice Address - Phone:740-438-2791
Practice Address - Fax:614-389-2290
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-00504231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLE4178991Medicare ID - Type UnspecifiedAUDIOLOGIST