Healthcare Provider Details

I. General information

NPI: 1083943658
Provider Name (Legal Business Name): DAVID LASZLO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SW 5TH ST
REDMOND OR
97756-2808
US

IV. Provider business mailing address

611 SW 5TH ST
REDMOND OR
97756-2808
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-3117
  • Fax: 541-923-0275
Mailing address:
  • Phone: 541-923-3117
  • Fax: 541-923-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number21844
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number21844
License Number StateOR

VIII. Authorized Official

Name: DR. DAVID A LASZLO
Title or Position: AUDIOLOGIST
Credential: AU.D
Phone: 541-923-3117