| Lifetime Vision Source Llc | |
|
90 Market St, Ste 20, Lebanon, OR 97355-2394 | |
| (541) 451-1144 | |
| (541) 451-1785 |
| Full Name | Lifetime Vision Source Llc |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 90 Market St, Lebanon, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710168877 | NPI | - | NPPES |
| 128772 | Medicaid | OR | |
| 232983 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 1400ATI (Oregon) | Primary |
| Provider Name | Roger Munk |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1316940281 PECOS PAC ID: 0042353104 Enrollment ID: I20100211000458 |
| Provider Name | Dennis Pearson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1356344220 PECOS PAC ID: 5092612549 Enrollment ID: I20100622000216 |
| Provider Name | Caitlin Squires |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1639731250 PECOS PAC ID: 5890021968 Enrollment ID: I20190726001416 |
| Provider Name | Ariene R Clark |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1467603225 PECOS PAC ID: 7416098553 Enrollment ID: I20210702001371 |
| Provider Name | Brandyn Wyatt |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1821773722 PECOS PAC ID: 0143689364 Enrollment ID: I20230706002840 |
| Provider Name | Luke Boran |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386329290 PECOS PAC ID: 9537528500 Enrollment ID: I20230709000079 |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Vision Source Llc 90 Market St, Ste 20, Lebanon, OR 97355-2394 Ph: (541) 451-1144 | Lifetime Vision Source Llc 90 Market St, Ste 20, Lebanon, OR 97355-2394 Ph: (541) 451-1144 |
Dr. Matthew Wayne Knecht, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 100 Mullins Dr Ste B3, Lebanon, OR 97355 Phone: 541-451-5808 Fax: 541-451-5813 | |
Roger Munk, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 90 Market St, Ste 20, Lebanon, OR 97355 Phone: 541-451-1144 Fax: 541-451-1785 | |
Dennis Pearson, OD Optometrist Medicare: Medicare Enrolled Practice Location: 90 Market St, Ste 20, Lebanon, OR 97355 Phone: 541-451-1144 Fax: 541-451-1785 | |
Luke Boran, OD Optometrist Medicare: Medicare Enrolled Practice Location: 90 Market St Ste 20, Lebanon, OR 97355 Phone: 541-451-2020 Fax: 541-451-1785 | |
Dr. Ariene R Clark, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 90 Market St Ste 20, Lebanon, OR 97355 Phone: 541-451-1144 Fax: 541-451-1785 | |
Caitlin Squires, OD Optometrist Medicare: Medicare Enrolled Practice Location: 90 Market St Ste 20, Lebanon, OR 97355 Phone: 541-451-1144 Fax: 541-451-1785 |