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Organization

LIFETIME VISION, PLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHERYL J. BRONNER O.D. (SOLE MEMBER)
(720) 363-3191
Entity
Organization

Contact information

Practice address
255 16TH ST SW, SIOUX CENTER, IA 51250-2959
(720) 363-3192
Mailing address
1626 7TH AVE SE, SIOUX CENTER, IA 51250-1197

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02040
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1194758581
IA
Enumeration date
08/03/2016
Last updated
08/03/2016
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