Provider Demographics
NPI:1053397273
Name:ASSOCIATION FOR THE BLIND AND VISUALLY IMPAIRED-GOODWILL INDUSTRIES OF
Entity type:Organization
Organization Name:ASSOCIATION FOR THE BLIND AND VISUALLY IMPAIRED-GOODWILL INDUSTRIES OF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KLEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-232-1111
Mailing Address - Street 1:422 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1103
Mailing Address - Country:US
Mailing Address - Phone:585-232-1111
Mailing Address - Fax:585-232-2972
Practice Address - Street 1:422 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1103
Practice Address - Country:US
Practice Address - Phone:585-232-1111
Practice Address - Fax:585-232-2972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATION FOR THE BLIND AND VISUALLY IMPAIRED-GOODWILL INDUSTRIES OF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0280Medicare ID - Type Unspecified
BA0280Medicare ID - Type Unspecified