Healthcare Provider Details

I. General information

NPI: 1629961263
Provider Name (Legal Business Name): GOODWILL VISION ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CLINTON AVE S
ROCHESTER NY
14620-1105
US

IV. Provider business mailing address

422 CLINTON AVE S
ROCHESTER NY
14620-1103
US

V. Phone/Fax

Practice location:
  • Phone: 585-402-2059
  • Fax: 585-510-2437
Mailing address:
  • Phone: 585-402-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224ZL0004X
TaxonomyLow Vision Occupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JO ELIZABETH RATH
Title or Position: DIRECTOR OF VISION SERVICES
Credential:
Phone: 585-402-2059