Lifetime Eyecare Center LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

OPC 1739 Issued in FL

Legal business name

LIFETIME EYECARE CENTER LLC

Practice address

5455 Murrell Rd
Suite 107
Viera, FL 32955-6615

Phone

(321) 636-1972

Fax

(321) 636-1507

NPI assigned

May 7, 2007

Last updated

Jan 4, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark Rowell Fisher, O.D.NPI 1275576712

Title

Optometric Physician

Phone

(321) 636-1972

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lifetime Eyecare Other name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Mark Rowell Fisher, OD

  • Optometrist
  • Rockledge, FL
  • NPI 1275576712
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294099200000",
    "number": "1619180775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 MURRELL RD",
            "address_2": "SUITE 107",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "329556615",
            "telephone_number": "321-636-1972",
            "fax_number": "321-636-1507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5455 MURRELL RD",
            "address_2": "SUITE 107",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "329556615",
            "telephone_number": "321-636-1972",
            "fax_number": "321-636-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME EYECARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2011-01-04",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ROWELL",
        "authorized_official_title_or_position": "OPTOMETRIC PHYSICIAN",
        "authorized_official_telephone_number": "321-636-1972",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "OPC 1739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "19829",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078956900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifetime Eyecare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Eyewear Supplier in Viera, FL
• Providers in Viera, FL by specialty
• Eyewear Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.