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General NPI Number Information
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NPI Number | 1053404467
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Entity Type | Organization
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Legal Business Name | VIRGINIA AUDIOLOGY INC
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1821 OLD DONATION PKWY STE 10
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-481-4003
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Fax | 757-481-4500
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Provider Business Mailing Address
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Address Line | 1821 OLD DONATION PKWY STE 10
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454
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Country | US
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Telephone | 757-481-4003
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Fax | 757-481-4500
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. GARY S LEFFKE
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Credential | AUD CCCA
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Telephone | 757-481-4003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 2006118011R
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License Number State | VA
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