Provider Demographics
NPI:1831275882
Name:CLOVERNOOK CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Entity type:Organization
Organization Name:CLOVERNOOK CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PROGRAM SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:USALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-522-3860
Mailing Address - Street 1:7000 HAMILTON AVE.
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5297
Mailing Address - Country:US
Mailing Address - Phone:513-522-3860
Mailing Address - Fax:513-728-3946
Practice Address - Street 1:368 BIELBY RD.
Practice Address - Street 2:SUITE #120
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1199
Practice Address - Country:US
Practice Address - Phone:812-537-0417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35027971152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCL9316301Medicare ID - Type Unspecified