Provider Demographics
NPI:1053506089
Name:VISION THERAPY SPECIALIST, PLLC
Entity type:Organization
Organization Name:VISION THERAPY SPECIALIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GLONEK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-969-5800
Mailing Address - Street 1:20789 N PIMA RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7204
Mailing Address - Country:US
Mailing Address - Phone:480-969-5800
Mailing Address - Fax:
Practice Address - Street 1:20789 N PIMA RD
Practice Address - Street 2:SUITE 145
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7204
Practice Address - Country:US
Practice Address - Phone:480-969-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ119699Medicare PIN