Organization
WORLD WIDE VISION THERAPY CENTERS, L.L.C.
Active
Other names
WOW VISION THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN L FORTENBACHER O.D. (OWNER)
(269) 983-3309
Entity
Organization
Contact information
Practice address
3152 PEREGRINE DR NE, SUITE C205, GRAND RAPIDS, MI 49525-9723
(616) 447-1444
(616) 447-1445
Mailing address
3152 PEREGRINE DR NE, SUITE C205, GRAND RAPIDS, MI 49525-9723
(616) 447-1444
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4901002693
MI
152WS0006X
Sports Vision Optometrist
4901002693
MI
152WV0400X
Vision Therapy Optometrist
Primary
4901002693
MI
152WV0400X
Vision Therapy Optometrist
4901004454
MI
152WV0400X
Vision Therapy Optometrist
4901004791
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900A165280
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
05/20/2015
Last updated
05/21/2015
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