=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699176461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID BASS MS, HAS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2014
-----------------------------------------------------
Last Update Date | 09/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 N CONGRESS AVE
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33426-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-369-5533
-----------------------------------------------------
Fax | 561-424-2926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 SEMORAN BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-940-4251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | AS4935
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------