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General NPI Number Information
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NPI Number | 1841574795
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO LIGHTHOUSE FOR THE BLIND
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 2300 ROOSEVELT AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78210-4921
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Country | US
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Telephone | 210-533-5195
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 ROOSEVELT AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78210-4920
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Country | US
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Telephone | 210-533-5195
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Fax | 210-533-4230
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. MIKE N GILLIAM
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Credential |
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Telephone | 210-533-5195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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