Healthcare Provider Details

I. General information

NPI: 1104913664
Provider Name (Legal Business Name): VISION FORWARD ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 W NATIONAL AVE STE 100
WEST ALLIS WI
53227-2160
US

IV. Provider business mailing address

10150 W NATIONAL AVE STE 100
WEST ALLIS WI
53227-2160
US

V. Phone/Fax

Practice location:
  • Phone: 414-615-0105
  • Fax: 414-238-2261
Mailing address:
  • Phone: 414-615-0105
  • Fax: 414-238-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: TERRI DAVIS
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential:
Phone: 414-615-0100