Healthcare Provider Details

I. General information

NPI: 1093921603
Provider Name (Legal Business Name): THE CHICAGO LIGHTHOUSE FOR PEOPLE WHO ARE BLIND OR VISUALLY IMPAIRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W ROOSEVELT RD
CHICAGO IL
60608-1200
US

IV. Provider business mailing address

1850 W ROOSEVELT RD
CHICAGO IL
60608-1228
US

V. Phone/Fax

Practice location:
  • Phone: 847-510-2053
  • Fax: 312-506-0103
Mailing address:
  • Phone: 312-666-1331
  • Fax: 312-506-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARLA GARSTKA
Title or Position: DIRECTOR
Credential:
Phone: 847-510-2053