Healthcare Provider Details

I. General information

NPI: 1356612345
Provider Name (Legal Business Name): BOB EVANS HEARING CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9156 SEMINOLE BLVD
SEMINOLE FL
33772-3148
US

IV. Provider business mailing address

9156 SEMINOLE BLVD
SEMINOLE FL
33772-3148
US

V. Phone/Fax

Practice location:
  • Phone: 727-393-3775
  • Fax:
Mailing address:
  • Phone: 727-393-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS1373
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAS1373
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT D EVANS
Title or Position: PRINCIPLE
Credential: BS;BC-HIS
Phone: 727-393-3775