MEDICARE: CLEAR CHOICE HEARING AID CENTERS, 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	332S00000X	Hearing Aid Equipment	17001207A	IN

General Provider Information

NPI Number	:	1689929929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR CHOICE HEARING AID CENTERS, LLC.

Provider Business Mailing Address
First Line	:	2901A E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-3545
Country	:	US
Telephone Number	:	765-488-0859
Fax Number	:	765-488-0869

Provider Business Practice Location Address
First Line	:	41 ROBIN HOOD LN
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1526
Country	:	US
Telephone Number	:	937-335-5551
Fax Number	:	937-335-5553

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RYAN LEE ANDERSON
Credential	:	HAD
Telephone Number	:	937-335-5551

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	07/23/2012

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