Provider Demographics
NPI:1841957339
Name:ROCKFORD VISION THERAPY LLC
Entity type:Organization
Organization Name:ROCKFORD VISION THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:202-308-4796
Mailing Address - Street 1:2745 10 MILE RD NE STE F
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7016
Mailing Address - Country:US
Mailing Address - Phone:616-951-7115
Mailing Address - Fax:616-951-7112
Practice Address - Street 1:2745 10 MILE RD NE STE F
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7016
Practice Address - Country:US
Practice Address - Phone:616-951-7115
Practice Address - Fax:616-951-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service