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General NPI Number Information
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NPI Number | 1780613182
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Entity Type | Individual
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Provider Name | THOMAS MARK ELLER
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3399 WEDGEWOOD LN
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City | LADY LAKE
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State | FL
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Zip | 32162-7180
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Country | US
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Telephone | 352-259-8070
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Fax | 352-259-8976
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Provider Business Mailing Address
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Address Line | 5000 CHESHIRE LN N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3706
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Country | US
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Telephone | 888-333-9152
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Fax | 763-268-4240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS2734
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License Number State | FL
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