Healthcare Provider Details

I. General information

NPI: 1003237082
Provider Name (Legal Business Name): VISION THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 S SHORE DR SUITE #101
BATTLE CREEK MI
49014-5466
US

IV. Provider business mailing address

395 S SHORE DR SUITE #101
BATTLE CREEK MI
49014-5466
US

V. Phone/Fax

Practice location:
  • Phone: 269-963-3600
  • Fax: 269-963-3495
Mailing address:
  • Phone: 269-963-3600
  • Fax: 269-963-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4901002642
License Number StateMI

VIII. Authorized Official

Name: AMANDA M BECK
Title or Position: INSURANCE BILLER
Credential:
Phone: 616-846-0620