=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902280167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE AUDIOLOGY & HEARING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2015
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17521 US HIGHWAY 441 STE 9
-----------------------------------------------------
City | MOUNT DORA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32757-6737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-729-0849
-----------------------------------------------------
Fax | 352-354-9100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17521 US HIGHWAY 441 STE 9
-----------------------------------------------------
City | MOUNT DORA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32757-6737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-729-0848
-----------------------------------------------------
Fax | 352-354-9100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/AUDIOLOGIST
-----------------------------------------------------
Name | ERICKA DEVORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-260-1818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AY1457
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------