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General NPI Number Information
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NPI Number | 1548338312
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Entity Type | Organization
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Legal Business Name | CUSTOM STYLE HEARING AIDS, INC.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3165 E CENTER STREET EXT
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City | WARSAW
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State | IN
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Zip | 46582-3901
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Country | US
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Telephone | 574-269-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 3165 E CENTER STREET EXT
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City | WARSAW
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State | IN
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Zip | 46582-3901
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Country | US
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Telephone | 574-269-6236
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICKI FISHER
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Credential |
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Telephone | 574-269-6236
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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 | 17001201A
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License Number State | IN
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