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General NPI Number Information
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NPI Number | 1396933107
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Entity Type | Organization
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Legal Business Name | LIFETIME VISION& CONTACTS P.C.
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 44345 PREMIER PLZ SUITE # 100
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City | ASHBURN
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State | VA
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Zip | 20147-5053
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Country | US
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Telephone | 703-729-8393
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Fax | 703-729-8394
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Provider Business Mailing Address
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Address Line | 44345 PREMIER PLZ SUITE # 100
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City | ASHBURN
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State | VA
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Zip | 20147-5053
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Country | US
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Telephone | 703-729-8393
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Fax | 703-729-8394
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GORDON VINCENT CULP JR.
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Credential | O.D.
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Telephone | 703-729-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0618000034
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License Number State | VA
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