Provider Demographics
NPI:1295343465
Name:LIFE VISION EYECARE, PLLC
Entity type:Organization
Organization Name:LIFE VISION EYECARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:269-367-2626
Mailing Address - Street 1:5770 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1159
Mailing Address - Country:US
Mailing Address - Phone:269-367-2626
Mailing Address - Fax:
Practice Address - Street 1:5770 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1159
Practice Address - Country:US
Practice Address - Phone:269-367-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty