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General NPI Number Information
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NPI Number | 1063897874
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Entity Type | Organization
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Legal Business Name | ADVANCE HEARING AID CENTER LLC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 1327 TOWNLINE AVE
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City | BELOIT
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State | WI
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Zip | 53511-4168
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Country | US
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Telephone | 608-362-2669
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Fax | 608-362-2669
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Provider Business Mailing Address
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Address Line | 1327 TOWNLINE AVE
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City | BELOIT
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State | WI
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Zip | 53511-4168
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Country | US
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Telephone | 608-362-2669
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Fax | 608-362-2669
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Authorized Official
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Title or Position | OWNER HEARING INSTRUMENT SPECIALIST
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Name | MS. SYNTHIA ANN POTUZNIK
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Credential | HEARING INSTR SPEC
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Telephone | 608-362-2669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 86460
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License Number State | WI
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