Provider Demographics
NPI:1609132224
Name:ANN ARBOR VISION THERAPY
Entity Type:Organization
Organization Name:ANN ARBOR VISION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SORTOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-926-0390
Mailing Address - Street 1:2433 OAK VALLEY DR
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-7602
Mailing Address - Country:US
Mailing Address - Phone:734-926-0390
Mailing Address - Fax:
Practice Address - Street 1:2433 OAK VALLEY DR
Practice Address - Street 2:SUITE 100B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-7602
Practice Address - Country:US
Practice Address - Phone:734-926-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANN ARBOR OPTOMETRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI490104033152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty