Provider Demographics
NPI:1194845339
Name:KEYSTONE BLIND ASSOCIATION
Entity Type:Organization
Organization Name:KEYSTONE BLIND ASSOCIATION
Other - Org Name:MERCER COUNTY BLIND ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-347-5501
Mailing Address - Street 1:1230 STAMBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2826
Mailing Address - Country:US
Mailing Address - Phone:724-347-5501
Mailing Address - Fax:724-347-2204
Practice Address - Street 1:1230 STAMBAUGH AVE
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-2826
Practice Address - Country:US
Practice Address - Phone:724-347-5501
Practice Address - Fax:724-347-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009752340001Medicaid