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General NPI Number Information
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NPI Number | 1386913689
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Entity Type | Organization
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Legal Business Name | ORANGE PARK AUDIOLOGY CLINIC
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Dates
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Enumeration Date | 12/16/2011
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 1542 KINGSLEY AVE SUITE 141
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City | ORANGE PARK
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State | FL
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Zip | 32073-4586
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Country | US
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Telephone | 904-278-9828
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Fax | 904-278-9818
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Provider Business Mailing Address
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Address Line | 1542 KINGSLEY AVE SUITE 141
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City | ORANGE PARK
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State | FL
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Zip | 32073-4586
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Country | US
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Telephone | 904-278-9828
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Fax | 904-278-9818
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. THOMAS FRANKLIN WILLIAMS JR.
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Credential | PHD.
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Telephone | 904-278-9828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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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 | AY1067
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License Number State | FL
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