Healthcare Provider Details

I. General information

NPI: 1710390232
Provider Name (Legal Business Name): BRIAN OLEJNICZAK H.A.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 S VOLUSIA AVE SUITE A
ORANGE CITY FL
32763-7649
US

IV. Provider business mailing address

2290 S VOLUSIA AVE SUITE A
ORANGE CITY FL
32763-7649
US

V. Phone/Fax

Practice location:
  • Phone: 386-624-6939
  • Fax:
Mailing address:
  • Phone: 386-624-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS-5031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: