Healthcare Provider Details

I. General information

NPI: 1083868319
Provider Name (Legal Business Name): NEW HORIZONS VISION THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 QUINN DR STE 400
WAUNAKEE WI
53597-2502
US

IV. Provider business mailing address

1021 QUINN DR STE 400
WAUNAKEE WI
53597-2502
US

V. Phone/Fax

Practice location:
  • Phone: 608-849-4040
  • Fax: 608-849-4042
Mailing address:
  • Phone: 608-849-4040
  • Fax: 608-849-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: VALERIE L FRAZER
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 608-849-4040