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General NPI Number Information
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NPI Number | 1720472814
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Entity Type | Organization
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Legal Business Name | CLEAR EAR HEARING OF NORTHEAST FLORIDA, LLC.
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 1871 WELLS RD STE 10
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City | ORANGE PARK
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State | FL
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Zip | 32073-2350
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Country | US
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Telephone | 904-579-4814
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Fax |
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Provider Business Mailing Address
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Address Line | 1871 WELLS RD STE 10
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City | ORANGE PARK
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State | FL
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Zip | 32073-2350
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TROY MAHAN
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Credential | HAS-NBC
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Telephone | 904-579-4814
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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 | AS 2210
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License Number State | FL
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