MEDICARE: CRYSTAL CLRAR 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	261QH0700X	Hearing and Speech Clinic/Center	HAD5414	AZ

General Provider Information

NPI Number	:	1598031650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL CLRAR HEARING

Provider Business Mailing Address
First Line	:	13925 W MEEKER BLVD STE 19
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-4432
Country	:	US
Telephone Number	:	623-755-8733
Fax Number	:	623-328-9757

Provider Business Practice Location Address
First Line	:	13925 W MEEKER BLVD STE 19
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-4432
Country	:	US
Telephone Number	:	623-755-8733
Fax Number	:	623-328-9757

Authorized Official
Title or Position	:	HEARING AID SPECIALIST
Name	:	MRS. LYNDA L ROBBINS
Credential	:	BCHIS
Telephone Number	:	623-755-8733

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/22/2012

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