Saint Joseph Vision Therapy LLC

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

Legal business name

SAINT JOSEPH VISION THERAPY LLC

Practice address

2908 Division St
Saint Joseph, MI 49085-2437

Phone

(269) 983-3309

Fax

(269) 983-0846

NPI assigned

Jan 31, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Charles Fortenbacher

Title

Cfo

Phone

(269) 449-1513

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Wow Vision Therapy Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alicia Bultsma, OD

  • Optometrist
  • Saint Joseph, MI
  • NPI 1992442792
  NPD (past)
• Dan Lee Fortenbacher, O.D.

  • Vision Therapy Optometrist
  • St Joseph, MI
  • NPI 1760519946
  NPD (past)
• Johann Josue Schlager, OD

  • Vision Therapy Optometrist
  • Merced, CA
  • NPI 1255986014
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1669937926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2908 DIVISION ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852437",
            "telephone_number": "269-983-3309",
            "fax_number": "269-983-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 DIVISION ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852437",
            "telephone_number": "269-983-3309",
            "fax_number": "269-983-0846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JOSEPH VISION THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "FORTENBACHER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "269-449-1513",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152WS0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "900A165280",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTOMETRY LICENSE",
            "identifier": "4901002693",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wow Vision Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shannon Ryan Whitman, PHYSICAL THERAPIST
• Katlyn Sacco
• Yamann Sahlool
• Hamza Saifuddin
• Saint Joseph Family Chiropractic P.C.
• Cynthia Salgado, FNP
• Jordan Ray Sall, D.O
• Anthony P Salvagione, M.D.
• Eliseo Sanchez Jr., LPC
• William Jay Sandor, MD

• Vision Therapy Optometrist in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Vision Therapy Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.