Organization
LIFETIME EYECARE CENTER LLC
Active
Other names
Lifetime Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ROWELL FISHER O.D. (OPTOMETRIC PHYSICIAN)
(321) 636-1972
Entity
Organization
Contact information
Practice address
5455 MURRELL RD, SUITE 107, VIERA, FL 32955-6615
(321) 636-1972
(321) 636-1507
Mailing address
5455 MURRELL RD, SUITE 107, VIERA, FL 32955-6615
(321) 636-1972
(321) 636-1507
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
OPC 1739
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078956900
—
FL
01
—
19829
BCBS OF FL
FL
Enumeration date
05/07/2007
Last updated
01/04/2011
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