Healthcare Provider Details

I. General information

NPI: 1023429628
Provider Name (Legal Business Name): OTOCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S VINE ST
PLAINFIELD IN
46168-1237
US

IV. Provider business mailing address

111 S VINE ST
PLAINFIELD IN
46168-1237
US

V. Phone/Fax

Practice location:
  • Phone: 317-203-5152
  • Fax: 317-203-5750
Mailing address:
  • Phone: 317-203-5152
  • Fax: 317-203-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001200A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JASON COOPER
Title or Position: OWNER
Credential: HEARING INSTRUMENT S
Phone: 317-203-5152