Provider Demographics
NPI:1649261900
Name:LIFETIME EYECARE ASSOCIATES PA
Entity type:Organization
Organization Name:LIFETIME EYECARE ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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 1:27214 KUYKENDAHL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3529
Mailing Address - Country:US
Mailing Address - Phone:281-465-8300
Mailing Address - Fax:281-465-8303
Practice Address - Street 1:27214 KUYKENDAHL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-465-8300
Practice Address - Fax:281-465-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2024-04-25
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