Provider Demographics
NPI:1083718100
Name:SOCIETY FOR THE BLIND
Entity Type:Organization
Organization Name:SOCIETY FOR THE BLIND
Other - Org Name:SOCIETY FOR THE BLIND, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINIC SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-452-8271
Mailing Address - Street 1:1238 S ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-7112
Mailing Address - Country:US
Mailing Address - Phone:916-452-8271
Mailing Address - Fax:916-492-2487
Practice Address - Street 1:1238 S ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-7112
Practice Address - Country:US
Practice Address - Phone:916-452-8271
Practice Address - Fax:916-492-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11669FMedicaid
CAZZR11669FMedicaid