Provider Demographics
NPI:1407368020
Name:LIFETIME VISION CARE, PC
Entity Type:Organization
Organization Name:LIFETIME VISION CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:571-436-0338
Mailing Address - Street 1:759 PALMDALE LN
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-6527
Mailing Address - Country:US
Mailing Address - Phone:571-436-0338
Mailing Address - Fax:
Practice Address - Street 1:232 NICKLE PLATE RD
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4416
Practice Address - Country:US
Practice Address - Phone:571-436-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-05
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1977152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty