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General NPI Number Information
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NPI Number | 1760849681
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Entity Type | Organization
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Legal Business Name | DYNAMIC CENTER FOR VISION THERAPY, P.C.
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 1891 BAY SCOTT CIR SUITE 109
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City | NAPERVILLE
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State | IL
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Zip | 60540-1137
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Country | US
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Telephone | 630-857-3873
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Fax |
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Provider Business Mailing Address
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Address Line | 1891 BAY SCOTT CIR SUITE 109
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City | NAPERVILLE
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State | IL
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Zip | 60540-1137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN EDWARDS
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Credential | O.D.
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Telephone | 701-320-3840
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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 |
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License Number State |
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