NPIMap

Organization Active NPI

Lifetime Vision Source of Lebanon LLC

  • Optometrist
  • Lebanon, OR
National Provider Identifier
1710168877
Registry record updated Dec 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1400ATI Issued in OR
Legal business name
LIFETIME VISION SOURCE OF LEBANON LLC
Practice address
90 Market St
Ste 20
Lebanon, OR 97355-2394
Phone
(541) 451-1144
Fax
(541) 451-1785
NPI assigned
Nov 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2008

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

Authorized official

Name
Teresa Turrentine
Title
Administrative Assistant
Phone
(541) 451-1144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1400ATI OR Primary

Addresses

Primary practice location

90 Market St
Ste 20
Lebanon, OR 97355-2394

Mailing address

90 Market St
Ste 20
Lebanon, OR 97355-2394
Phone (541) 451-1144

Other identifiers 2

IdentifierTypeStateIssuer
128772MedicaidOR
232983MedicaidOR

Other names 1

  • Lifetime Vision Source LLC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000247 OR Part B Supplier - Clinic/Group Practice 6608773148 Receives reassigned benefits from 5 practitioners
Practice locations: Lebanon, OR
O20100930073931 OR DME Supplier - Physician - OptometristDME Supplier - Optician 6608773148 Practice locations: Lebanon, OR

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2076583Lifetime Vision Source of Lebanon90 Market St Ste 20, Lebanon, OR 97355Certificate of waiverApr 21, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Lifetime Vision Source of Lebanon90 Market St, Lebanon, OR 97355-2396(541) 451-1144 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1710168877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 MARKET ST",
            "address_2": "STE 20",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552394",
            "telephone_number": "541-451-1144",
            "fax_number": "541-451-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 MARKET ST",
            "address_2": "STE 20",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552394",
            "telephone_number": "541-451-1144",
            "fax_number": "541-451-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETIME VISION SOURCE OF LEBANON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "TURRENTINE",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "541-451-1144"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OR",
            "license": "1400ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128772",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232983",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifetime Vision Source LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lebanon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; 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.