Healthcare Provider Details

I. General information

NPI: 1053704940
Provider Name (Legal Business Name): LIFETIME VISION CARE TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N MAYS ST
ROUND ROCK TX
78664-4317
US

IV. Provider business mailing address

408 N MAYS ST
ROUND ROCK TX
78664-4317
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-2003
  • Fax: 512-949-5120
Mailing address:
  • Phone: 512-244-2003
  • Fax: 512-949-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7253TG
License Number StateTX

VIII. Authorized Official

Name: CHRISTOPHER EUGENIO
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 512-244-2003