Provider Demographics
NPI:1053842419
Name:VISION THERAPY CENTER OF WISCONSIN, LLC
Entity type:Organization
Organization Name:VISION THERAPY CENTER OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-637-7494
Mailing Address - Street 1:1421 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-2254
Mailing Address - Country:US
Mailing Address - Phone:262-637-7494
Mailing Address - Fax:262-637-7958
Practice Address - Street 1:1421 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2254
Practice Address - Country:US
Practice Address - Phone:262-637-7494
Practice Address - Fax:262-637-7958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISION CLINIC DR. SAVIN AND ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1567152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty