Healthcare Provider Details

I. General information

NPI: 1497893671
Provider Name (Legal Business Name): CENTER FOR THE VISUALLY IMPAIRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 W PEACHTREE ST NW
ATLANTA GA
30308-1137
US

IV. Provider business mailing address

739 W PEACHTREE ST NW
ATLANTA GA
30308-1137
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-9011
  • Fax: 404-607-0062
Mailing address:
  • Phone: 404-875-9011
  • Fax: 404-607-0062

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: MR. WILLIAM W. WOOLF
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential:
Phone: 404-875-9011