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General NPI Number Information
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NPI Number | 1528452869
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Entity Type | Organization
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Legal Business Name | HEAR-MART, LLC
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 7702 CASS AVE STE 110
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City | DARIEN
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State | IL
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Zip | 60561-5093
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Country | US
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Telephone | 630-541-8308
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Fax | 630-541-8308
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Provider Business Mailing Address
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Address Line | 9142 SHENANDOAH RUN
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-5455
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Country | US
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Telephone | 815-782-8318
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Fax | 815-782-8397
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Authorized Official
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Title or Position | OWNER
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Name | JASON PETTY
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Credential |
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Telephone | 618-803-9230
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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 |
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License Number State |
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