Provider Demographics
NPI:1497893671
Name:CENTER FOR THE VISUALLY IMPAIRED
Entity Type:Organization
Organization Name:CENTER FOR THE VISUALLY IMPAIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-875-9011
Mailing Address - Street 1:739 W PEACHTREE ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1137
Mailing Address - Country:US
Mailing Address - Phone:404-875-9011
Mailing Address - Fax:404-607-0062
Practice Address - Street 1:739 W PEACHTREE ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1137
Practice Address - Country:US
Practice Address - Phone:404-875-9011
Practice Address - Fax:404-607-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7122Medicare PIN