Provider Demographics
NPI:1669625877
Name:VISION THERAPY ACADEMY, LLC
Entity type:Organization
Organization Name:VISION THERAPY ACADEMY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-788-4300
Mailing Address - Street 1:3424 MORMON COULEE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6750
Mailing Address - Country:US
Mailing Address - Phone:608-788-5380
Mailing Address - Fax:608-788-4325
Practice Address - Street 1:3424 MORMON COULEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6750
Practice Address - Country:US
Practice Address - Phone:608-788-5380
Practice Address - Fax:608-788-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2949-035152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty