Healthcare Provider Details

I. General information

NPI: 1396856381
Provider Name (Legal Business Name): LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/28/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MARKET ST FL 10
SAN FRANCISCO CA
94103-1540
US

IV. Provider business mailing address

1155 MARKET ST FL 10
SAN FRANCISCO CA
94103-1540
US

V. Phone/Fax

Practice location:
  • Phone: 415-431-1481
  • Fax:
Mailing address:
  • Phone: 415-431-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON GIOVINAZZO
Title or Position: CEO
Credential:
Phone: 415-694-7346