Provider Demographics
NPI:1881708238
Name:COMMUNITY SERVICES FOR VISION REHABILITATION, INC.
Entity type:Organization
Organization Name:COMMUNITY SERVICES FOR VISION REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-476-4744
Mailing Address - Street 1:600 BEL AIR BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-3511
Mailing Address - Country:US
Mailing Address - Phone:251-476-4744
Mailing Address - Fax:
Practice Address - Street 1:600 BEL AIR BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3511
Practice Address - Country:US
Practice Address - Phone:251-476-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529918300Medicaid
AL529918300Medicaid
ALC78072Medicare UPIN