MEDICARE: CUSTOM HEARING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment

General Provider Information

NPI Number	:	1063765691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSTOM HEARING

Provider Business Mailing Address
First Line	:	131 ENTERPRISE RD
Second Line	:
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3326
Country	:	US
Telephone Number	:	401-353-4174
Fax Number	:	401-488-5774

Provider Business Practice Location Address
First Line	:	245 CENTER ST
Second Line	:	SUITE 3
City	:	AUBURN
State	:	ME
Zip	:	04210-6169
Country	:	US
Telephone Number	:	207-344-6146
Fax Number	:	207-344-6142

Authorized Official
Title or Position	:	HEARING INSTRUMENT SPECIALIST
Name	:	JASON FRASIER
Credential	:
Telephone Number	:	207-344-6146

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	06/02/2020

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