Provider Demographics
NPI:1073746434
Name:BENJAMIN W. NORRIS INC.
Entity Type:Organization
Organization Name:BENJAMIN W. NORRIS INC.
Other - Org Name:MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEARING SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:254-751-1100
Mailing Address - Street 1:812 LAKE AIR DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5745
Mailing Address - Country:US
Mailing Address - Phone:254-751-1100
Mailing Address - Fax:187-777-6167
Practice Address - Street 1:812 LAKE AIR DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5745
Practice Address - Country:US
Practice Address - Phone:254-751-1100
Practice Address - Fax:187-777-6167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50235332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528252459OtherINDIVIDUAL NPI #
TX201942401Medicaid