Healthcare Provider Details

I. General information

NPI: 1215312897
Provider Name (Legal Business Name): GLEN HEARING ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3373 PRINCETON RD SUITE D117
HAMILTON OH
45011-5416
US

IV. Provider business mailing address

1001 E. SUNSET ROAD UNIT 96595
LAS VEGAS NV
89193-1246
US

V. Phone/Fax

Practice location:
  • Phone: 513-895-4327
  • Fax: 513-894-4327
Mailing address:
  • Phone: 702-798-0113
  • Fax: 866-291-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number03273
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number03273
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02225
License Number StateOH

VIII. Authorized Official

Name: CHRISTOPHER A GLEN
Title or Position: OWNER
Credential: HAS
Phone: 513-895-4327