Developmental Vision Center Inc

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

046007841 Issued in IL

Legal business name

DEVELOPMENTAL VISION CENTER INC

Practice address

2075 Wiesbrook Rd
Oswego, IL 60543-8312

Phone

(630) 844-0908

Fax

(630) 844-0677

NPI assigned

Nov 3, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Chula Lerdvoratavee, O.D.

Title

President

Phone

(630) 844-0908

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Vasana Lerdvoratavee, O.D.

  • Vision Therapy Optometrist
  • Montgomery, IL
  • NPI 1356332423
  NPD (past)

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

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1932352994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 WIESBROOK RD",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438312",
            "telephone_number": "630-844-0908",
            "fax_number": "630-844-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 WIESBROOK RD",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438312",
            "telephone_number": "630-844-0908",
            "fax_number": "630-844-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVELOPMENTAL VISION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-03",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "LERDVORATAVEE",
        "authorized_official_first_name": "CHULA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-844-0908",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "IL",
            "license": "046007841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vision Therapy Optometrist in Oswego, IL
• Providers in Oswego, IL by specialty
• Vision Therapy Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; 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.