MEDICARE: THE CHICAGO LIGHTHOUSE FOR PEOPLE WHO ARE BLIND OR VISUALLY IMPAIRED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YP2500X	Professional Counselor
2	103TC0700X	Clinical Psychologist	IL
3	1041C0700X	Clinical Social Worker	IL
4	152W00000X	Optometrist	IL
5	174400000X	Specialist	IL
6	225X00000X	Occupational Therapist	IL
7	225XP0200X	Pediatric Occupational Therapist	IL
8	332B00000X	Durable Medical Equipment & Medical Supplies
9	152WL0500X	Low Vision Rehabilitation Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1111300	OTHER	IL	BLUE CROSS AND BLUE SHIELD OF ILLINOIS
2	1831182377	OTHER	IL	NPI

General Provider Information

NPI Number	:	1043326309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHICAGO LIGHTHOUSE FOR PEOPLE WHO ARE BLIND OR VISUALLY IMPAIRED

Provider Business Mailing Address
First Line	:	1850 W ROOSEVELT RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1200
Country	:	US
Telephone Number	:	312-666-1331
Fax Number	:	312-997-3663

Provider Business Practice Location Address
First Line	:	1850 W ROOSEVELT ROAD
Second Line	:	THE CHICAGO LIGHTHOUSE
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	312-666-1331
Fax Number	:	312-997-3663

Authorized Official
Title or Position	:	MEDICAL BILLING MANAGER
Name	:	GABRIELLE NIEWINSKI
Credential	:	CPB, CPC
Telephone Number	:	312-666-1331

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	04/03/2023

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Directions to “THE CHICAGO LIGHTHOUSE FOR PEOPLE WHO ARE BLIND OR VISUALLY IMPAIRED ” Practice Location

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