=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205247186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT AUDIO INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 05/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 E BUSINESS CENTER DR SUITE 109
-----------------------------------------------------
City | MOUNT PROSPECT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60056-6040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-421-0843
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 E BUSINESS CENTER DR SUITE 109
-----------------------------------------------------
City | MOUNT PROSPECT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60056-6040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-421-0843
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUDIOLOGIST
-----------------------------------------------------
Name | DR. WILLIAM BIELSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-421-0843
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 147001447
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------