MEDICARE: LIFETIME EYECARE ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1621	SC

General Provider Information

NPI Number	:	1164715843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME EYECARE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2428 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-576-7225
Fax Number	:	864-576-7226

Provider Business Practice Location Address
First Line	:	2428 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-576-7225
Fax Number	:	864-576-7226

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEREMY R BURNS
Credential	:	OD
Telephone Number	:	864-576-7225

Provider Enumeration Date	:	05/27/2011
Last Update Date	:	05/27/2011

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