NPIMap

Organization Active NPI

Carol P. Lagrange, O.D., P.C.

Doing business as Lifetime EyeCare

  • Optometrist
  • Jackson, TN
National Provider Identifier
1972520807
Registry record updated Aug 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODT831 Issued in TN
Legal business name
CAROL P. LAGRANGE, O.D., P.C.
Doing business as
Lifetime EyeCare
Practice address
2043 Greystone Park
Jackson, TN 38305-3575
Phone
(731) 668-3424
Fax
(731) 668-3425
NPI assigned
Jul 16, 2006
Last updated
Aug 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2012

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

Authorized official

Name
Dr. Stephanie Phillips Layman, O.D.NPI 1477515856
Title
Owner
Phone
(731) 668-3424

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
Optometrist 152W00000X ODT831 TN Primary

Addresses

Primary practice location

2043 Greystone Park
Jackson, TN 38305-3575

Mailing address

2043 Greystone Park
Jackson, TN 38305-3575
Phone (731) 668-3424

Other identifiers 3

IdentifierTypeStateIssuer
28639OtherTNBLUE CROSS & BLUE SHIELD
3596185MedicaidTN
0657400001OtherTNDMERIC

Other names 1

  • Lifetime EyeCare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060720000374 TN Part B Supplier - Clinic/Group Practice 3375556152 Receives reassigned benefits from 2 practitioners
Practice locations: Jackson, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345420800000",
    "number": "1972520807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2043 GREYSTONE PARK",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053575",
            "telephone_number": "731-668-3424",
            "fax_number": "731-668-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2043 GREYSTONE PARK",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053575",
            "telephone_number": "731-668-3424",
            "fax_number": "731-668-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROL P. LAGRANGE, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2012-08-20",
        "status": "A",
        "authorized_official_last_name": "LAYMAN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "PHILLIPS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-668-3424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "ODT831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "28639",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3596185",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERIC",
            "identifier": "0657400001",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifetime EyeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2012; 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.