Healthcare Provider Details

I. General information

NPI: 1346537701
Provider Name (Legal Business Name): VISION LEARNING CENTER OF AVON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 E. US HIGHWAY 36 SUITE 200
AVON IN
46123-0533
US

IV. Provider business mailing address

5055 E. US HIGHWAY 36 SUITE 200
AVON IN
46123-0533
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-7000
  • Fax: 317-745-2294
Mailing address:
  • Phone: 317-745-7000
  • Fax: 317-745-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number18003213
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number18003213
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003213
License Number StateIN

VIII. Authorized Official

Name: DR. AMANDA E. JUDSON
Title or Position: OWNER/OPTOMETRIST
Credential: OD, MS, FCOVD
Phone: 317-745-7000