Provider Demographics
NPI:1053704940
Name:LIFETIME VISION CARE TEXAS, PLLC
Entity type:Organization
Organization Name:LIFETIME VISION CARE TEXAS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EUGENIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-244-2003
Mailing Address - Street 1:408 N MAYS ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4317
Mailing Address - Country:US
Mailing Address - Phone:512-244-2003
Mailing Address - Fax:512-949-5120
Practice Address - Street 1:408 N MAYS ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4317
Practice Address - Country:US
Practice Address - Phone:512-244-2003
Practice Address - Fax:512-949-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7253TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty