Healthcare Provider Details

I. General information

NPI: 1659701449
Provider Name (Legal Business Name): CENTRAL FLORIDA AUDIOLOGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17421 SE 155TH AVE
WEIRSDALE FL
32195-3138
US

IV. Provider business mailing address

17421 SE 155TH AVE
WEIRSDALE FL
32195-3138
US

V. Phone/Fax

Practice location:
  • Phone: 352-303-3929
  • Fax:
Mailing address:
  • Phone: 352-303-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RICE
Title or Position: PRESIDENT
Credential:
Phone: 352-303-3929