Provider Demographics
NPI:1912267956
Name:LIFETIME EYECARE CENTER SC
Entity Type:Organization
Organization Name:LIFETIME EYECARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-831-2033
Mailing Address - Street 1:7425 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3111
Mailing Address - Country:US
Mailing Address - Phone:608-831-2033
Mailing Address - Fax:608-831-0152
Practice Address - Street 1:7425 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3111
Practice Address - Country:US
Practice Address - Phone:608-831-2033
Practice Address - Fax:608-831-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1740-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty