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General NPI Number Information
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NPI Number | 1194845339
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Entity Type | Organization
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Legal Business Name | KEYSTONE BLIND ASSOCIATION
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1230 STAMBAUGH AVE
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City | SHARON
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State | PA
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Zip | 16146-2826
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Country | US
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Telephone | 724-347-5501
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Fax | 724-347-2204
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Provider Business Mailing Address
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Address Line | 1230 STAMBAUGH AVE
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City | SHARON
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State | PA
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Zip | 16146-2826
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Country | US
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Telephone | 724-347-5501
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Fax | 724-347-2204
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | JONATHAN FISTER
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Credential |
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Telephone | 724-347-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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