1154553857 NPI number — VISION DEVELOPMENT CENTER

Table of content: (NPI 1154553857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154553857 NPI number — VISION DEVELOPMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION DEVELOPMENT CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154553857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9412 E STATE ROAD 64
Provider Second Line Business Mailing Address:
APT A
Provider Business Mailing Address City Name:
VELPEN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47590-8857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-631-1888
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 W 36TH ST
Provider Second Line Business Practice Location Address:
STE. 240
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47546-7849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-481-2100
Provider Business Practice Location Address Fax Number:
812-481-2144
Provider Enumeration Date:
08/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BAUERNFIEND
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-631-1888

Provider Taxonomy Codes

  • Taxonomy code: 152WV0400X , with the licence number:  18003529A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com