Provider Demographics
NPI:1396933107
Name:LIFETIME VISION& CONTACTS P.C.
Entity type:Organization
Organization Name:LIFETIME VISION& CONTACTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:CULP
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:703-729-8393
Mailing Address - Street 1:44345 PREMIER PLZ
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5053
Mailing Address - Country:US
Mailing Address - Phone:703-729-8393
Mailing Address - Fax:703-729-8394
Practice Address - Street 1:44345 PREMIER PLZ
Practice Address - Street 2:SUITE # 100
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5053
Practice Address - Country:US
Practice Address - Phone:703-729-8393
Practice Address - Fax:703-729-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000034261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10452Medicare PIN