Provider Demographics
NPI:1861540163
Name:TEWIS, BARRY W (O D)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:W
Last Name:TEWIS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6700
Mailing Address - Country:US
Mailing Address - Phone:601-264-6688
Mailing Address - Fax:601-264-3393
Practice Address - Street 1:102 N 38TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6700
Practice Address - Country:US
Practice Address - Phone:601-264-6688
Practice Address - Fax:601-264-3393
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist