| Organization Name: | SENSORY SOURCE, LLC |
| NPI Number: | 1326268186 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICIA MARIE ROSLUND (OPTOMETRIST, LLC MANAGER) |
| Mailing Address: | 11301 Commerce Dr Suite A Allendale |
| State: | MI US |
| Postal Code: | 494018200 |
| Phone Number: | 6168959550 |
| Fax Number: | 6168925166 |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WV0400X |
| License Number: | 4901003210 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Vision Therapy |
| Taxonomy Definition: | Optometrists who specialize in vision therapy as a treatment process used to improve vision function. It includes a broad range of developmental and rehabilitative treatment programs individually prescribed to remediate specific sensory, motor and/or visual perceptual dysfunctions. |