Provider Demographics
NPI:1699785626
Name:ASSOCIATION FOR THE BLIND & VISUALLY IMPAIRED
Entity type:Organization
Organization Name:ASSOCIATION FOR THE BLIND & VISUALLY IMPAIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-458-7113
Mailing Address - Street 1:456 CHERRY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4626
Mailing Address - Country:US
Mailing Address - Phone:616-458-1187
Mailing Address - Fax:616-458-7113
Practice Address - Street 1:456 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4626
Practice Address - Country:US
Practice Address - Phone:616-458-1187
Practice Address - Fax:616-458-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M06190Medicare ID - Type Unspecified