Healthcare Provider Details

I. General information

NPI: 1699785626
Provider Name (Legal Business Name): ASSOCIATION FOR THE BLIND & VISUALLY IMPAIRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 CHERRY ST SE
GRAND RAPIDS MI
49503-4626
US

IV. Provider business mailing address

456 CHERRY ST SE
GRAND RAPIDS MI
49503-4626
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-1187
  • Fax: 616-458-7113
Mailing address:
  • Phone: 616-458-1187
  • Fax: 616-458-7113

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: RICHARD A STEVENS
Title or Position: DIRECTOR
Credential:
Phone: 616-458-7113