Provider Demographics
NPI:1588878870
Name:LIGHTHOUSE FOR THE BLIND OF HOUSTON
Entity type:Organization
Organization Name:LIGHTHOUSE FOR THE BLIND OF HOUSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GIBSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTERROIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-284-8420
Mailing Address - Street 1:3602 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-1704
Mailing Address - Country:US
Mailing Address - Phone:713-284-8494
Mailing Address - Fax:713-284-8468
Practice Address - Street 1:3602 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-1704
Practice Address - Country:US
Practice Address - Phone:713-284-8494
Practice Address - Fax:713-284-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000329100OtherDAHS
TX000321000OtherDAHS
TX001000741OtherDB WAIVER
TX001000741OtherDB WAIVER