Healthcare Provider Details

I. General information

NPI: 1881978997
Provider Name (Legal Business Name): CUSTOM HEARING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8712 WYOMING ST
OMAHA NE
68122-5245
US

IV. Provider business mailing address

8712 WYOMING ST
OMAHA NE
68122-5245
US

V. Phone/Fax

Practice location:
  • Phone: 402-515-9228
  • Fax: 866-826-9730
Mailing address:
  • Phone: 402-515-9228
  • Fax: 866-826-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number900773
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number900773
License Number StateNE

VIII. Authorized Official

Name: TERRY LEE ORESKOVICH JR.
Title or Position: OWNER/OPERATOR
Credential: HIS
Phone: 402-515-9228