Provider Demographics
NPI:1992971584
Name:LUM EYE AND VISION CENTER, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:LUM EYE AND VISION CENTER, A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERMUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-648-6891
Mailing Address - Street 1:3088 TELEGRAPH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3234
Mailing Address - Country:US
Mailing Address - Phone:805-648-6891
Mailing Address - Fax:805-648-6386
Practice Address - Street 1:3088 TELEGRAPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3234
Practice Address - Country:US
Practice Address - Phone:805-648-6891
Practice Address - Fax:805-648-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty