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General NPI Number Information
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NPI Number | 1548303019
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Entity Type | Organization
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Legal Business Name | BLIND AND LOW VISION REHABILITATION SERVICES & CONSULTING, INC.
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2625 SW 75TH ST 1301
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City | GAINESVILLE
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State | FL
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Zip | 32607-6636
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Country | US
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Telephone | 352-246-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 SW 75TH ST 1301
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City | GAINESVILLE
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State | FL
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Zip | 32607-6636
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Country | US
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Telephone | 352-246-9578
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERIC EUGENE HICKS
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Credential | MS OTRL
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Telephone | 352-246-9578
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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 | OT11044
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License Number State | FL
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