Provider Demographics
NPI:1760730592
Name:CHAUTAUQUA BLIND ASSOCIATION
Entity Type:Organization
Organization Name:CHAUTAUQUA BLIND ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODELL
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:716-664-6660
Mailing Address - Street 1:510 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4813
Mailing Address - Country:US
Mailing Address - Phone:716-664-6660
Mailing Address - Fax:716-664-1193
Practice Address - Street 1:510 W 5TH ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4813
Practice Address - Country:US
Practice Address - Phone:716-664-6660
Practice Address - Fax:716-664-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care