Provider Demographics
NPI:1457330433
Name:LIFETIME EYECARE, P.C.
Entity Type:Organization
Organization Name:LIFETIME EYECARE, P.C.
Other - Org Name:LIFETIME EYECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-345-5800
Mailing Address - Street 1:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-1808
Mailing Address - Country:US
Mailing Address - Phone:308-345-5800
Mailing Address - Fax:308-345-5802
Practice Address - Street 1:218 WEST D STREET
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-1808
Practice Address - Country:US
Practice Address - Phone:308-345-5800
Practice Address - Fax:308-345-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1049152W00000X
NE1088152W00000X
KS1636152W00000X
KS1529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDH2197Medicare PIN
NE93151Medicare PIN
KS0360340001Medicare NSC
NE0360340001Medicare NSC
KS065077Medicare PIN