Provider Demographics
NPI:1275617227
Name:LIGHT AND VISION, INC
Entity Type:Organization
Organization Name:LIGHT AND VISION, INC
Other - Org Name:SOUTHERN FOCUS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-631-7700
Mailing Address - Street 1:PO BOX 1919
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-1919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:754 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2696
Practice Address - Country:US
Practice Address - Phone:205-631-7700
Practice Address - Fax:205-631-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS754TA234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529804360Medicaid
AL529804360Medicaid
AL1306000001Medicare NSC