Provider Demographics
NPI:1720385263
Name:LVCTR PC
Entity Type:Organization
Organization Name:LVCTR PC
Other - Org Name:LIFETIME VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:B
Authorized Official - Last Name:YUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-746-6745
Mailing Address - Street 1:2900 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6070
Mailing Address - Country:US
Mailing Address - Phone:701-746-6745
Mailing Address - Fax:701-746-6961
Practice Address - Street 1:2900 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6070
Practice Address - Country:US
Practice Address - Phone:701-746-6745
Practice Address - Fax:701-746-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty