Provider Demographics
NPI:1588806624
Name:VISUAL VICTORY TRAINING, PLLC
Entity Type:Organization
Organization Name:VISUAL VICTORY TRAINING, PLLC
Other - Org Name:VISUAL VICTORY TRAINING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:PRUSZENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-766-4548
Mailing Address - Street 1:150 GRIFFIN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7131
Mailing Address - Country:US
Mailing Address - Phone:603-766-4548
Mailing Address - Fax:
Practice Address - Street 1:161 DEER ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3905
Practice Address - Country:US
Practice Address - Phone:603-766-4548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH609152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty