Organization
LIFETIME VISION SOURCE OF LEBANON LLC
Active
Other names
Lifetime Vision Source LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA TURRENTINE (ADMINISTRATIVE ASSISTANT)
(541) 451-1144
Entity
Organization
Contact information
Practice address
90 MARKET ST, STE 20, LEBANON, OR 97355-2394
(541) 451-1144
(541) 451-1785
Mailing address
90 MARKET ST, STE 20, LEBANON, OR 97355-2394
(541) 451-1144
(541) 451-1785
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1400ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128772
—
OR
05
—
232983
—
OR
Enumeration date
11/16/2007
Last updated
12/02/2008
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