Provider Demographics
NPI:1508332586
Name:LOW VISION SKILLS REHABILITATION AND CONSULTING LLC
Entity Type:Organization
Organization Name:LOW VISION SKILLS REHABILITATION AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:470-407-9909
Mailing Address - Street 1:1046 LEGACY WALK
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5240
Mailing Address - Country:US
Mailing Address - Phone:216-469-9909
Mailing Address - Fax:
Practice Address - Street 1:1046 LEGACY WALK
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5240
Practice Address - Country:US
Practice Address - Phone:216-469-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003130420AMedicaid