=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649608423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMPLY HEAR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2013
-----------------------------------------------------
Last Update Date | 06/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2635 WHEATON WAY
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98310-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-373-2571
-----------------------------------------------------
Fax | 360-479-4970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2635 WHEATON WAY
-----------------------------------------------------
City | BREMERTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98310-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-373-2571
-----------------------------------------------------
Fax | 360-479-4970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBIN FISCUS
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 360-373-2571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | LD60183332
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------