Provider Demographics
NPI:1104913664
Name:VISION FORWARD ASSOCIATION, INC.
Entity type:Organization
Organization Name:VISION FORWARD ASSOCIATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-615-0100
Mailing Address - Street 1:912 N HAWLEY RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3222
Mailing Address - Country:US
Mailing Address - Phone:414-615-0112
Mailing Address - Fax:414-615-0167
Practice Address - Street 1:912 N HAWLEY RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-3222
Practice Address - Country:US
Practice Address - Phone:414-615-0112
Practice Address - Fax:414-615-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000081067Medicare ID - Type UnspecifiedMEDICARE