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General NPI Number Information
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NPI Number | 1811704869
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Entity Type | Individual
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Provider Name | MATTHEW A THORNTON HAS
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Gender | Male
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 364 W FAIRBANKS AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-5093
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Country | US
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Telephone | 321-295-8014
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 BLACK LAKE BLVD
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4756
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Country | US
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Telephone | 407-446-2470
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Fax |
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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 | AS5862
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License Number State | FL
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