=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376877670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION THERAPY CENTER OF INDIANA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2009
-----------------------------------------------------
Last Update Date | 11/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7440 N SHADELAND AVE SUITE #160
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46250-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-915-1515
-----------------------------------------------------
Fax | 317-915-3946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7440 N SHADELAND AVE SUITE #160
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46250-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-915-1515
-----------------------------------------------------
Fax | 317-915-3946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MRS. CYNTHIA J FRISCHMANN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 317-915-1515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WV0400X
-----------------------------------------------------
Taxonomy Name | Vision Therapy Optometrist
-----------------------------------------------------
License Number | 18002565A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------