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General NPI Number Information
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NPI Number | 1396466926
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Entity Type | Organization
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Legal Business Name | LIFETIME NEURO-VISION THERAPY INC.
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 3632 10TH LN NW STE 1
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City | ROCHESTER
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State | MN
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Zip | 55901-7032
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Country | US
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Telephone | 507-282-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 3632 10TH LN NW STE 1
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City | ROCHESTER
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State | MN
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Zip | 55901-7032
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Country | US
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Telephone | 507-282-7121
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Fax |
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Authorized Official
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Title or Position | ACCOUNTING
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Name | TERESA LEE ANDERSON
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Credential |
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Telephone | 507-282-7121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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