Healthcare Provider Details

I. General information

NPI: 1205424900
Provider Name (Legal Business Name): LIFETIME EYE CARE, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 18TH ST
CHARLESTON IL
61920-3607
US

IV. Provider business mailing address

1700 18TH ST
CHARLESTON IL
61920-3607
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-6600
  • Fax: 217-345-6622
Mailing address:
  • Phone: 217-345-6600
  • Fax: 217-345-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: NANCY HENDRIX
Title or Position: INSURANCE/BILLING
Credential:
Phone: 217-345-6600