1396933107 NPI number — LIFETIME VISION& CONTACTS P.C.

Table of content: DENISE LYNN DAVIS M.D. (NPI 1164522389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396933107 NPI number — LIFETIME VISION& CONTACTS P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFETIME VISION& CONTACTS P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396933107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44345 PREMIER PLZ
Provider Second Line Business Mailing Address:
SUITE # 100
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-5053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-729-8393
Provider Business Mailing Address Fax Number:
703-729-8394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44345 PREMIER PLZ
Provider Second Line Business Practice Location Address:
SUITE # 100
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-5053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-729-8393
Provider Business Practice Location Address Fax Number:
703-729-8394
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CULP
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-729-8393

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  0618000034 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com