Healthcare Provider Details

I. General information

NPI: 1396903233
Provider Name (Legal Business Name): THE VISION THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13255 W BLUEMOUND RD SUITE 200
BROOKFIELD WI
53005-6245
US

IV. Provider business mailing address

13255 W BLUEMOUND RD SUITE 200
BROOKFIELD WI
53005-6245
US

V. Phone/Fax

Practice location:
  • Phone: 262-784-9201
  • Fax: 262-784-9206
Mailing address:
  • Phone: 262-784-9201
  • Fax: 262-784-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number2553-035
License Number StateWI

VIII. Authorized Official

Name: MISS KELLYE JOY KNUEPPEL
Title or Position: PRESIDENT
Credential: OD, FCOVD
Phone: 262-784-9201