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General NPI Number Information
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NPI Number | 1316816416
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE FOR THE BLIND AND VISUALLY IMPAIRED
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 4539 OCCIDENTAL RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-5635
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Country | US
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Telephone | 707-523-3222
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Fax | 415-694-7330
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Provider Business Mailing Address
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Address Line | 4539 OCCIDENTAL RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-5635
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Country | US
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Telephone | 707-523-3222
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Fax | 415-694-7330
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Authorized Official
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Title or Position | INTERIM CEO / CHIEF OPERATING OFFIC
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Name | WILLIAM BRANDON COX
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Credential |
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Telephone | 415-694-7347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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