Basic Information
| Provider Information | |||||||||
| NPI: | 1801383260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISION THERAPY INSTITUTE OF MI, LLC | ||||||||
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| OtherOrganizationName: | VISION THERAPY INSTITUTE | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 W LAKE LANSING RD | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488231438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173378182 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 W LAKE LANSING RD | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488238527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173378182 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2018 | ||||||||
| LastUpdateDate: | 04/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | VINCENT-RIEMER | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5173378182 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WV0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Vision Therapy |
No ID Information.