Healthcare Provider Details

I. General information

NPI: 1386945640
Provider Name (Legal Business Name): RICHARD R. NAMIKAS, M.S., CCC-A, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 CENTER RD
VENICE FL
34285-5572
US

IV. Provider business mailing address

524 BELLAIRE DR
VENICE FL
34293-3801
US

V. Phone/Fax

Practice location:
  • Phone: 941-496-9277
  • Fax: 941-496-9522
Mailing address:
  • Phone: 941-493-4472
  • Fax: 941-496-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY251
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD NAMIKAS
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 941-496-9277