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General NPI Number Information
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NPI Number | 1174712772
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Entity Type | Organization
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Legal Business Name | FAIRBORN HEARING AID CENTER
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 331 N BROAD ST
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City | FAIRBORN
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State | OH
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Zip | 45324-4934
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Country | US
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Telephone | 937-879-1842
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Fax |
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Provider Business Mailing Address
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Address Line | 331 N BROAD ST
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City | FAIRBORN
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State | OH
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Zip | 45324-4934
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Country | US
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Telephone | 937-879-1842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLYDE L REDD JR.
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Credential | BC-HIS
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Telephone | 937-879-1842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 1918
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License Number State | OH
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