MEDICARE: PERSONAL EAR PRODUCTS, LLC

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1538582218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL EAR PRODUCTS, LLC

Provider Business Mailing Address
First Line	:	4950 KELLER SPRINGS RD STE 190
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-5929
Country	:	US
Telephone Number	:	469-893-9090
Fax Number	:	972-458-0234

Provider Business Practice Location Address
First Line	:	4950 KELLER SPRINGS RD STE 190
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-5929
Country	:	US
Telephone Number	:	469-893-9090
Fax Number	:	972-458-0234

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN TOLLEY
Credential	:	M.S., CCC/A
Telephone Number	:	469-893-9090

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	01/30/2014

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Directions to “PERSONAL EAR PRODUCTS, LLC ” Practice Location

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