Healthcare Provider Details

I. General information

NPI: 1386626307
Provider Name (Legal Business Name): HELEN KELLER SERVICES FOR THE BLIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WILLOUGHBY ST
BROOKLYN NY
11201-5290
US

IV. Provider business mailing address

57 WILLOUGHBY ST
BROOKLYN NY
11201-5290
US

V. Phone/Fax

Practice location:
  • Phone: 718-522-2122
  • Fax: 718-935-9463
Mailing address:
  • Phone: 718-522-2122
  • Fax: 718-935-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number7001202R
License Number StateNY

VIII. Authorized Official

Name: WILLIAM FRANCIS DALE
Title or Position: CLINICAL DIRECTOR
Credential: MA
Phone: 516-485-1234