Provider Demographics
NPI:1043458870
Name:COLUMBIA LIGHTHOUSE FOR THE BLIND
Entity Type:Organization
Organization Name:COLUMBIA LIGHTHOUSE FOR THE BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CANCELOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-454-6410
Mailing Address - Street 1:1825 K ST NW
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1202
Mailing Address - Country:US
Mailing Address - Phone:202-454-6400
Mailing Address - Fax:202-454-6401
Practice Address - Street 1:1825 K ST NW
Practice Address - Street 2:SUITE 1103
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1202
Practice Address - Country:US
Practice Address - Phone:202-454-6400
Practice Address - Fax:202-454-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty