Organization
LIFETIME VISION 20/20
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE J MOTACEK OD (MANAGER)
(701) 252-2020
Entity
Organization
Contact information
Practice address
300 2ND AVE NE STE 102, JAMESTOWN, ND 58401-3373
(701) 252-2020
(701) 251-2801
Mailing address
300 2ND AVE NE, JAMESTOWN, ND 58401
(701) 252-2020
(701) 251-2801
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
486
ND
152W00000X
Optometrist
502
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60038
—
ND
Enumeration date
01/25/2007
Last updated
07/31/2024
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