Provider Demographics
NPI:1295911345
Name:LIFETIME EYECARE ASSOCIATES PA
Entity type:Organization
Organization Name:LIFETIME EYECARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-465-8300
Mailing Address - Street 1:8765 SPRING CYPRESS RD STE N
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3195
Mailing Address - Country:US
Mailing Address - Phone:281-655-9595
Mailing Address - Fax:
Practice Address - Street 1:8765 SPRING CYPRESS RD STE N
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3195
Practice Address - Country:US
Practice Address - Phone:281-655-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6168T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU92487Medicare UPIN
TX00628ZMedicare PIN