NPIMap

Organization Active NPI

Lifetime Vision & Contact Lens Center, LTD.

  • Optometrist
  • Crystal Lake, IL
National Provider Identifier
1679625966
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046007026 Issued in IL
Legal business name
LIFETIME VISION & CONTACT LENS CENTER, LTD.
Practice address
300 Memorial Dr
Suite 300
Crystal Lake, IL 60014-6278
Phone
(815) 459-7110
Fax
(815) 459-7138
NPI assigned
Jan 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Authorized official

Name
Dr. Lamont M Sprague, O.D.NPI 1215009832
Title
President
Phone
(815) 459-7110

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 046007026 IL Primary

Addresses

Primary practice location

300 Memorial Dr
Suite 300
Crystal Lake, IL 60014-6278

Mailing address

300 Memorial Dr
Suite 300
Crystal Lake, IL 60014-6278
Phone (815) 459-7110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081118000431 IL Part B Supplier - Clinic/Group Practice 1557421757 Receives reassigned benefits from 3 practitioners
Practice locations: Crystal Lake, IL

National Provider Directory

National Provider Directory

Locations

300 Memorial Dr
Ste 300
Crystal Lake, IL 60014
Phone (815) 459-7110

300 Memorial Dr
Crystal Lake, IL 60014
Phone (815) 459-7110

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1679625966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MEMORIAL DR",
            "address_2": "SUITE 300",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146278",
            "telephone_number": "815-459-7110",
            "fax_number": "815-459-7138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MEMORIAL DR",
            "address_2": "SUITE 300",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146278",
            "telephone_number": "815-459-7110",
            "fax_number": "815-459-7138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME VISION & CONTACT LENS CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "SPRAGUE",
        "authorized_official_first_name": "LAMONT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-459-7110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.