MEDICARE: VISION THERAPY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WV0400X	Vision Therapy Optometrist	4901002642	MI

General Provider Information

NPI Number	:	1003237082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISION THERAPY CENTER

Provider Business Mailing Address
First Line	:	395 S SHORE DR
Second Line	:	SUITE #101
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5466
Country	:	US
Telephone Number	:	269-963-3600
Fax Number	:	269-963-3495

Provider Business Practice Location Address
First Line	:	395 S SHORE DR
Second Line	:	SUITE #101
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5466
Country	:	US
Telephone Number	:	269-963-3600
Fax Number	:	269-963-3495

Authorized Official
Title or Position	:	INSURANCE BILLER
Name	:	AMANDA M BECK
Credential	:
Telephone Number	:	616-846-0620

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	12/18/2013

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Directions to “VISION THERAPY CENTER ” Practice Location

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