Provider Demographics
NPI:1386723906
Name:LIFETIME EYECARE OPTOMETRY
Entity type:Organization
Organization Name:LIFETIME EYECARE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-477-3211
Mailing Address - Street 1:11398 KENYON WAY STE C
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9229
Mailing Address - Country:US
Mailing Address - Phone:909-477-3211
Mailing Address - Fax:909-477-3213
Practice Address - Street 1:11398 KENYON WAY STE C
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-9229
Practice Address - Country:US
Practice Address - Phone:909-477-3211
Practice Address - Fax:909-477-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty