Healthcare Provider Details

I. General information

NPI: 1386782258
Provider Name (Legal Business Name): RICHARD PERRY TIBBILS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 TAMIAMI TRL S STE B
VENICE FL
34293-3129
US

IV. Provider business mailing address

1872 TAMIAMI TRL S STE B
VENICE FL
34293-3129
US

V. Phone/Fax

Practice location:
  • Phone: 941-244-2922
  • Fax: 941-244-2923
Mailing address:
  • Phone: 941-244-2922
  • Fax: 941-244-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1477
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1481
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: