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General NPI Number Information
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NPI Number | 1093415515
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Entity Type | Organization
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Legal Business Name | LAKE AUDIOLOGY INC
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 15243 FOREST RD STE D
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City | FOREST
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State | VA
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Zip | 24551-4974
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Country | US
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Telephone | 434-266-9898
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Fax | 434-266-9848
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Provider Business Mailing Address
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Address Line | 15243 FOREST RD STE D
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City | FOREST
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State | VA
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Zip | 24551-4974
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Country | US
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Telephone | 434-266-9898
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Fax | 434-266-9848
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALYSON LAKE
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Credential | AUD, PHD
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Telephone | 434-266-9898
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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 |
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License Number State |
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