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GRAND RAPIDS VISION THERAPY LLC NPI 1568932994


NPI Information

NPI: 1568932994
Provider Name: GRAND RAPIDS VISION THERAPY LLC
Classification: Optometrist - 152WV0400X
Entity Type: Organization

Specialization: Vision Therapy

Address:
3152 PEREGRINE DR NE STE C205
GRAND RAPIDS, MI
ZIP 49525
Phone: (616) 447-1444
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GRAND RAPIDS VISION THERAPY LLC is a vision therapy optometrist in Grand Rapids, MI. The provider is optometrists who specialize in vision therapy as a treatment process used to improve vision function. It includes a broad range of developmental and rehabilitative treatment programs individually prescribed to remediate specific sensory, motor and/or visual perceptual dysfunctions. GRAND RAPIDS VISION THERAPY LLC NPI is 1568932994. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3152 PEREGRINE DR NE STE C205
GRAND RAPIDS, MI
ZIP 49525-723
Phone: (616) 447-1444

The provider's authorized official is Charles Ian Fortenbacher .
The authorized official title is Cfo and has the following contact phone number (616) 447-1444.

The enumeration date for this NPI number is 11/28/2018 and was last updated on 11/28/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1152WS0006XOptometristSports VisionNo
2152WV0400XOptometristVision TherapyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
14901004973OTHERMICHIGANOPTOMETRY LICENSE
24901002693OTHERMICHIGANOPTOMETRY LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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