Provider Demographics
NPI:1548303019
Name:BLIND AND LOW VISION REHABILITATION SERVICES & CONSULTING, INC.
Entity type:Organization
Organization Name:BLIND AND LOW VISION REHABILITATION SERVICES & CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTRL
Authorized Official - Phone:352-246-9578
Mailing Address - Street 1:2625 SW 75TH ST
Mailing Address - Street 2:1301
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6636
Mailing Address - Country:US
Mailing Address - Phone:352-246-9578
Mailing Address - Fax:
Practice Address - Street 1:2625 SW 75TH ST
Practice Address - Street 2:1301
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6636
Practice Address - Country:US
Practice Address - Phone:352-246-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8908044Medicaid
FLK7600Medicare ID - Type UnspecifiedOTPP
FL8908044Medicaid