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General NPI Number Information
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NPI Number | 1871733535
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Entity Type | Organization
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Legal Business Name | LIFETIME VISION CARE
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 119 SUMMIT ST
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City | CELINA
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State | OH
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Zip | 45822-1023
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Country | US
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Telephone | 419-586-5149
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Fax | 419-586-3122
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Provider Business Mailing Address
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Address Line | 119 SUMMIT ST
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City | CELINA
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State | OH
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Zip | 45822-1023
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Country | US
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Telephone | 419-586-5149
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Fax | 419-586-3122
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. PAUL W WILKEN
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Credential | O.D.
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Telephone | 419-586-5149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3317
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License Number State | OH
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