Healthcare Provider Details

I. General information

NPI: 1083718100
Provider Name (Legal Business Name): SOCIETY FOR THE BLIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 S ST
SACRAMENTO CA
95811-7112
US

IV. Provider business mailing address

1238 S ST
SACRAMENTO CA
95811-7112
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-8271
  • Fax: 916-492-2487
Mailing address:
  • Phone: 916-452-8271
  • Fax: 916-492-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: PENNY RILEY
Title or Position: DIRECTOR OF CLINIC SERVICES
Credential:
Phone: 916-452-8271