Provider Demographics
NPI:1003435348
Name:DALLAS LIGHTHOUSE FOR THE BLIND, INC
Entity Type:Organization
Organization Name:DALLAS LIGHTHOUSE FOR THE BLIND, INC
Other - Org Name:ENVISION DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR REHABILITATION SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-440-1600
Mailing Address - Street 1:4306 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3624
Mailing Address - Country:US
Mailing Address - Phone:214-420-6552
Mailing Address - Fax:214-823-6339
Practice Address - Street 1:4306 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3624
Practice Address - Country:US
Practice Address - Phone:214-420-6552
Practice Address - Fax:214-823-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty