NPIMap

Organization Active NPI

Lifetime Eyehealth Associates PC

  • Optometrist
  • Davenport, IA
National Provider Identifier
1053501585
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
01826 Issued in IA
Legal business name
LIFETIME EYEHEALTH ASSOCIATES PC
Practice address
1718 E Kimberly Rd
Davenport, IA 52807-2029
Phone
(563) 355-3912
Fax
(563) 359-4108
NPI assigned
Jul 31, 2007
Last updated
Aug 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dan Stadelman, ODNPI 1770501801
Title
OD/President
Phone
(563) 355-3912

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 01826 IA Primary

Addresses

Primary practice location

1718 E Kimberly Rd
Davenport, IA 52807-2029

Mailing address

1718 E Kimberly Rd
Davenport, IA 52807-2029
Phone (563) 355-3912

Other names 1

  • LIFETIME EYEHEALTH ASSOCIATES Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211026002512 IA Part B Supplier - Clinic/Group Practice 3779971676 Receives reassigned benefits from 4 practitioners
Practice locations: Davenport, IA
O20220113000067 IA DME Supplier - Physician - Optometrist 3779971676 Practice locations: Davenport, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Lifetime Eyehealth Associates PC1718 E Kimberly Rd, Davenport, IA 52807-2097(563) 355-3912 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Locations

1718 E Kimberly Rd
Davenport, IA 52807
Phone (563) 355-3912

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1053501585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 E KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072029",
            "telephone_number": "563-355-3912",
            "fax_number": "563-359-4108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 E KIMBERLY RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072029",
            "telephone_number": "563-355-3912",
            "fax_number": "563-359-4108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME EYEHEALTH ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-31",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "STADELMAN",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "OD/PRESIDENT",
        "authorized_official_telephone_number": "563-355-3912",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFETIME EYEHEALTH ASSOCIATES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.