MEDICARE: WAYNE NOLAN TUCK LHIS

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	237700000X	Hearing Instrument Specialist	2179	AL

General Provider Information

NPI Number	:	1538512140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE NOLAN TUCK LHIS

Provider Business Mailing Address
First Line	:	1491 MONTGOMERY HWY
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3633
Country	:	US
Telephone Number	:	205-824-8170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1491 MONTGOMERY HWY
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3633
Country	:	US
Telephone Number	:	205-824-8170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	07/19/2016

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Directions to “ WAYNE NOLAN TUCK LHIS” Practice Location

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