NPIMap

Organization Active NPI

Dallas Lighthouse for the Blind, Inc

  • Low Vision Occupational Therapist
  • Farmers Branch, TX
National Provider Identifier
1003435348
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Low Vision Occupational TherapistTaxonomy code 225XL0004X
Legal business name
DALLAS LIGHTHOUSE FOR THE BLIND, INC
Practice address
1801 Valley View LN
Farmers Branch, TX 75234-8906
Phone
(214) 420-6552
Fax
(214) 823-6339
NPI assigned
Apr 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacy R Fuller
Title
Sr. Director Rehabilitation Service
Phone
(316) 440-1600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Low Vision Rehabilitation OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WL0500X
Low Vision Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XL0004X Primary

Addresses

Primary practice location

1801 Valley View LN
Farmers Branch, TX 75234-8906

Mailing address

1801 Valley View LN
Farmers Branch, TX 75234-8906
Phone (214) 420-6552

Other names 1

  • Envision Dallas Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200623001237 TX Part B Supplier - Clinic/Group Practice 0840612735 Receives reassigned benefits from 2 practitioners
Practice locations: Farmers Branch, TX

National Provider Directory

National Provider Directory

Locations

1801 Valley View Ln
Farmers Branch, TX 75234
Phone (214) 420-5090

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1003435348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 VALLEY VIEW LN",
            "city": "FARMERS BRANCH",
            "state": "TX",
            "postal_code": "752348906",
            "telephone_number": "214-420-6552",
            "fax_number": "214-823-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 VALLEY VIEW LN",
            "city": "FARMERS BRANCH",
            "state": "TX",
            "postal_code": "752348906",
            "telephone_number": "214-420-6552",
            "fax_number": "214-823-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS LIGHTHOUSE FOR THE BLIND, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-15",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SR. DIRECTOR REHABILITATION SERVICE",
        "authorized_official_telephone_number": "316-440-1600"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XL0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Low Vision",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Dallas",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Envision Dallas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmers Branch, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.