Healthcare Provider Details

I. General information

NPI: 1104124387
Provider Name (Legal Business Name): REALEAR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PALM COAST PKWY SW SUITE #109
PALM COAST FL
32137-4746
US

IV. Provider business mailing address

1000 PALM COAST PKWY SW SUITE #109
PALM COAST FL
32137-4746
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-3530
  • Fax: 386-447-3633
Mailing address:
  • Phone: 386-447-3530
  • Fax: 386-447-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY W. SMITH
Title or Position: VICE PRESIDENT
Credential: BC-HAS-ACA
Phone: 386-447-3530