Provider Demographics
NPI:1316816416
Name:LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED
Entity type:Organization
Organization Name:LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO / CHIEF OPERATING OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-694-7347
Mailing Address - Street 1:4539 OCCIDENTAL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5635
Mailing Address - Country:US
Mailing Address - Phone:707-523-3222
Mailing Address - Fax:415-694-7330
Practice Address - Street 1:4539 OCCIDENTAL RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5635
Practice Address - Country:US
Practice Address - Phone:707-523-3222
Practice Address - Fax:415-694-7330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty