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General NPI Number Information
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NPI Number | 1407368020
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Entity Type | Organization
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Legal Business Name | LIFETIME VISION CARE, PC
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Dates
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Enumeration Date | 11/05/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 232 NICKLE PLATE RD
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City | HARDEEVILLE
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State | SC
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Zip | 29927-4416
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Country | US
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Telephone | 571-436-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 759 PALMDALE LN
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City | OKATIE
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State | SC
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Zip | 29909-6527
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Country | US
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Telephone | 571-436-0338
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Fax |
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. KATHLEEN A CLARY
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Credential | OD
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Telephone | 571-436-0338
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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 | 1977
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License Number State | SC
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