Healthcare Provider Details

I. General information

NPI: 1346588191
Provider Name (Legal Business Name): EAR-RESISTIBLE HEARING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 US HIGHWAY 41 BYP S
VENICE FL
34285-5545
US

IV. Provider business mailing address

1287 US HIGHWAY 41 BYP S
VENICE FL
34285-5545
US

V. Phone/Fax

Practice location:
  • Phone: 941-257-0530
  • Fax: 941-375-0142
Mailing address:
  • Phone: 941-257-0530
  • Fax: 941-375-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAS4425
License Number StateFL

VIII. Authorized Official

Name: MR. CHAD FONDER
Title or Position: OWNER
Credential: HAS
Phone: 941-257-0530