Provider Demographics
NPI:1356991624
Name:VISION THERAPY CENTER LLC
Entity type:Organization
Organization Name:VISION THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-342-0258
Mailing Address - Street 1:5734 SHERIDAN LAKE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8814
Mailing Address - Country:US
Mailing Address - Phone:605-342-0258
Mailing Address - Fax:605-342-0209
Practice Address - Street 1:5734 SHERIDAN LAKE RD STE 202
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8814
Practice Address - Country:US
Practice Address - Phone:605-342-0258
Practice Address - Fax:605-342-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty