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General NPI Number Information
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NPI Number | 1912209768
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Entity Type | Organization
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Legal Business Name | FAMILY VISION THERAPY PC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 10/01/2011
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Provider Practice Location Address
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Address Line | 444 N EOLA RD #105
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City | AURORA
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State | IL
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Zip | 60502-9615
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Country | US
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Telephone | 630-862-2020
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Fax | 630-862-2027
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Provider Business Mailing Address
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Address Line | 444 N EOLA RD #105
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City | AURORA
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State | IL
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Zip | 60502-9615
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Country | US
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Telephone | 630-862-2020
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Fax | 630-862-2027
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MARTIN
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Credential | OD
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Telephone | 630-862-2020
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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 | 046-009753
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License Number State | IL
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