Healthcare Provider Details

I. General information

NPI: 1093922049
Provider Name (Legal Business Name): EASTSIDE HEARING AID CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7580 AUBURN ROAD #103
PAINESVILLE OH
44077
US

IV. Provider business mailing address

7580 AUBURN ROAD #103
PAINESVILLE OH
44077
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-1474
  • Fax: 440-352-2662
Mailing address:
  • Phone: 440-352-1474
  • Fax: 440-352-2662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02797
License Number StateOH

VIII. Authorized Official

Name: E LUKE BOLD
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 440-352-1474