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General NPI Number Information
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NPI Number | 1487880100
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Entity Type | Organization
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Legal Business Name | VISUAL EXPERIENCES
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 4244 INDIAN RIPPLE RD
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City | DAYTON
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State | OH
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Zip | 45440-3279
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Country | US
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Telephone | 937-320-0400
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Fax | 937-320-0500
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Provider Business Mailing Address
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Address Line | 4244 INDIAN RIPPLE RD
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City | DAYTON
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State | OH
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Zip | 45440-3279
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Country | US
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Telephone | 937-320-0400
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Fax | 937-320-0500
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Authorized Official
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Title or Position | PARTNER
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Name | DR. BRENDA H MONTECALVO
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Credential | OD
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Telephone | 937-320-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4167
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License Number State | OH
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