Provider Demographics
NPI:1356309637
Name:LIFETIME EYECARE SPECIALISTS, PC
Entity Type:Organization
Organization Name:LIFETIME EYECARE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:LOHR
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:719-266-9095
Mailing Address - Street 1:13570 MEADOWGRASS DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3058
Mailing Address - Country:US
Mailing Address - Phone:719-266-9095
Mailing Address - Fax:719-266-9068
Practice Address - Street 1:13570 MEADOWGRASS DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3058
Practice Address - Country:US
Practice Address - Phone:719-266-9095
Practice Address - Fax:719-266-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1859152W00000X
CO1970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO464818Medicare UPIN
COU67182Medicare UPIN