Healthcare Provider Details

I. General information

NPI: 1396466926
Provider Name (Legal Business Name): LIFETIME NEURO-VISION THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 10TH LN NW STE 1
ROCHESTER MN
55901-7032
US

IV. Provider business mailing address

3632 10TH LN NW STE 1
ROCHESTER MN
55901-7032
US

V. Phone/Fax

Practice location:
  • Phone: 507-282-7121
  • Fax:
Mailing address:
  • Phone: 507-282-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: TERESA LEE ANDERSON
Title or Position: ACCOUNTING
Credential:
Phone: 507-282-7121