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General NPI Number Information
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NPI Number | 1407201114
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Entity Type | Organization
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Legal Business Name | LIFETIME VISON AND EYE CARE INC.
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Dates
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Enumeration Date | 05/01/2016
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Last Update Date | 05/01/2016
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Provider Practice Location Address
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Address Line | 1600 SW 78TH AVE APT 422
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City | PLANTATION
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State | FL
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Zip | 33324-3392
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Country | US
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Telephone | 954-600-5975
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 SW 78TH AVE APT 422
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City | PLANTATION
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State | FL
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Zip | 33324-3392
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Country | US
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Telephone | 954-600-5975
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN J THAYIL
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Credential | OD
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Telephone | 954-600-5975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4836
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License Number State | FL
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