Healthcare Provider Details

I. General information

NPI: 1922103209
Provider Name (Legal Business Name): TOLEDO SOCIETY FOR THE BLIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 GARDEN LAKE PKWY
TOLEDO OH
43614-2780
US

IV. Provider business mailing address

1002 GARDEN LAKE PKWY
TOLEDO OH
43614-2780
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-3937
  • Fax: 419-720-3938
Mailing address:
  • Phone: 419-720-3937
  • Fax: 419-720-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State

VIII. Authorized Official

Name: STACEY BUTTS
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 419-720-3937