Healthcare Provider Details

I. General information

NPI: 1215069372
Provider Name (Legal Business Name): SOUTH DAYTON HEARING AIDS & AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E STROOP RD
KETTERING OH
45429
US

IV. Provider business mailing address

1305 E STROOP RD
KETTERING OH
45429
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-2004
  • Fax: 937-299-0918
Mailing address:
  • Phone: 937-299-2004
  • Fax: 937-299-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA00106
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberA00106
License Number StateOH

VIII. Authorized Official

Name: MR. THOMAS CARL LOLAN
Title or Position: MA FAAA
Credential: AUD
Phone: 937-299-2004