Provider Demographics
NPI:1255983185
Name:BEYOND 20-20 VISION THERAPY LLC
Entity type:Organization
Organization Name:BEYOND 20-20 VISION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KISELICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-785-8298
Mailing Address - Street 1:309 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1835
Mailing Address - Country:US
Mailing Address - Phone:715-748-2020
Mailing Address - Fax:715-748-4565
Practice Address - Street 1:309 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1835
Practice Address - Country:US
Practice Address - Phone:715-748-2020
Practice Address - Fax:715-748-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty