Provider Demographics
NPI:1154553857
Name:VISION DEVELOPMENT CENTER
Entity type:Organization
Organization Name:VISION DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUERNFIEND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-631-1888
Mailing Address - Street 1:9412 E STATE ROAD 64
Mailing Address - Street 2:APT A
Mailing Address - City:VELPEN
Mailing Address - State:IN
Mailing Address - Zip Code:47590-8857
Mailing Address - Country:US
Mailing Address - Phone:812-631-1888
Mailing Address - Fax:
Practice Address - Street 1:255 W 36TH ST
Practice Address - Street 2:STE. 240
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-7849
Practice Address - Country:US
Practice Address - Phone:812-481-2100
Practice Address - Fax:812-481-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003529A152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty