Healthcare Provider Details

I. General information

NPI: 1619007333
Provider Name (Legal Business Name): SALVATORE N IMPERATO HEARING INSTRUMENT S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 MAIN STREET SOUTH
SOUTH BARRE MA
01074
US

IV. Provider business mailing address

395 MAIN STREET SOUTH PO BOX 78
SOUTH BARRE MA
01074
US

V. Phone/Fax

Practice location:
  • Phone: 978-355-2191
  • Fax: 978-355-2020
Mailing address:
  • Phone: 978-355-2191
  • Fax: 978-355-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number4043
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number4043
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0034
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number0034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: