Provider Demographics
NPI:1760813851
Name:TUCSON VISION REHAB, LLC
Entity Type:Organization
Organization Name:TUCSON VISION REHAB, LLC
Other - Org Name:LOW VISION REHABILITATION OF SOUTHERN ARIZONA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:520-271-1725
Mailing Address - Street 1:800 N SWAN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1262
Mailing Address - Country:US
Mailing Address - Phone:520-303-5689
Mailing Address - Fax:520-303-5785
Practice Address - Street 1:800 N SWAN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1262
Practice Address - Country:US
Practice Address - Phone:520-303-5689
Practice Address - Fax:520-303-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2531225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty