MEDICARE: LIFETIME EYECARE SPECIALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1970	CO
2	152W00000X	Optometrist	1859	CO

General Provider Information

NPI Number	:	1356309637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME EYECARE SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	13570 MEADOWGRASS DRIVE
Second Line	:	SUITE 205
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3058
Country	:	US
Telephone Number	:	719-266-9095
Fax Number	:	719-266-9068

Provider Business Practice Location Address
First Line	:	13570 MEADOWGRASS DRIVE
Second Line	:	SUITE 205
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3058
Country	:	US
Telephone Number	:	719-266-9095
Fax Number	:	719-266-9068

Authorized Official
Title or Position	:	OPTOMETRIST/CEO
Name	:	DAVID THEODORE LOHR II
Credential	:	O.D.
Telephone Number	:	719-266-9095

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/05/2010

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