Provider Demographics
NPI:1346499100
Name:VISION LEARNING CENTER OF TERRE HAUTE
Entity Type:Organization
Organization Name:VISION LEARNING CENTER OF TERRE HAUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-232-1000
Mailing Address - Street 1:3630 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5543
Mailing Address - Country:US
Mailing Address - Phone:812-232-1000
Mailing Address - Fax:812-232-1007
Practice Address - Street 1:3630 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5543
Practice Address - Country:US
Practice Address - Phone:812-232-1000
Practice Address - Fax:812-232-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003213A152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1255367686OtherPROVIDER NPI