Healthcare Provider Details

I. General information

NPI: 1376877670
Provider Name (Legal Business Name): VISION THERAPY CENTER OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 N SHADELAND AVE SUITE #160
INDIANAPOLIS IN
46250-2029
US

IV. Provider business mailing address

7440 N SHADELAND AVE SUITE #160
INDIANAPOLIS IN
46250-2029
US

V. Phone/Fax

Practice location:
  • Phone: 317-915-1515
  • Fax: 317-915-3946
Mailing address:
  • Phone: 317-915-1515
  • Fax: 317-915-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number18002565A
License Number StateIN

VIII. Authorized Official

Name: MRS. CYNTHIA J FRISCHMANN
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 317-915-1515