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General NPI Number Information
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NPI Number | 1942120555
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Entity Type | Organization
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Legal Business Name | INDIANA VISION DEVELOPMENT CENTER II LLC
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 10343 DAWSONS CREEK BLVD STE B
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City | FORT WAYNE
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State | IN
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Zip | 46825-1906
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Country | US
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Telephone | 260-497-7973
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Fax |
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Provider Business Mailing Address
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Address Line | 10343 DAWSONS CREEK BLVD STE B
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City | FORT WAYNE
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State | IN
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Zip | 46825-1906
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Country | US
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Telephone | 260-497-7973
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE FRYE
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Credential | OD
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Telephone | 260-497-7973
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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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