Provider Demographics
NPI:1851605240
Name:BEHAVIORAL VISION, LTD.
Entity Type:Organization
Organization Name:BEHAVIORAL VISION, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:SYPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-455-2800
Mailing Address - Street 1:820 E TERRA COTTA AVE
Mailing Address - Street 2:SUITE 256
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3649
Mailing Address - Country:US
Mailing Address - Phone:815-455-2800
Mailing Address - Fax:815-455-2801
Practice Address - Street 1:820 E TERRA COTTA AVE
Practice Address - Street 2:SUITE 256
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3649
Practice Address - Country:US
Practice Address - Phone:815-455-2800
Practice Address - Fax:815-455-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009482152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3549Medicare PIN