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General NPI Number Information
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NPI Number | 1548628415
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Entity Type | Organization
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Legal Business Name | ACADEMY OF VISION DEVELOPMENT, PLLC
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 6617 CROSSINGS DR SE SUITE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-7378
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Country | US
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Telephone | 616-541-7080
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Fax | 616-541-7088
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Provider Business Mailing Address
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Address Line | 6617 CROSSINGS DR SE SUITE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-7378
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Country | US
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Telephone | 616-541-7080
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Fax | 616-541-7088
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Authorized Official
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Title or Position | SOLE OWNER/MEMBER
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Name | DR. ANGELA L SANDERS
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Credential | OD
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Telephone | 616-485-9804
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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 | 4901004369
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License Number State | MI
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