Healthcare Provider Details

I. General information

NPI: 1518802404
Provider Name (Legal Business Name): OASIS HEARING CARE OF ORANGE PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1494 PARK AVE STE 1494
ORANGE PARK FL
32073-4908
US

IV. Provider business mailing address

9611 CUSTER RD APT 1936
PLANO TX
75025-6564
US

V. Phone/Fax

Practice location:
  • Phone: 904-644-8779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER MC KEE HANSEN JR.
Title or Position: CHIEF EXECUTIVE MANAGER
Credential:
Phone: 212-444-8552