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General NPI Number Information
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NPI Number | 1184919599
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Entity Type | Organization
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Legal Business Name | BALDWIN OPTICAL AND HEARING AID COMPANY LLC
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 310 E LAUREL AVE
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City | FOLEY
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State | AL
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Zip | 36535-2618
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Country | US
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Telephone | 251-943-1758
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Fax | 251-943-7999
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Provider Business Mailing Address
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Address Line | 310 E LAUREL AVE
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City | FOLEY
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State | AL
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Zip | 36535-2618
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Country | US
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Telephone | 251-943-1758
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Fax | 251-943-7999
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MR. YUN KOL PAK
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Credential | ABOC; BC-HIS
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Telephone | 251-943-1758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 008831
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 4055
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License Number State | AL
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