Provider Demographics
NPI:1093195059
Name:PARK CITY HEARING AID INC.
Entity Type:Organization
Organization Name:PARK CITY HEARING AID INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-374-6107
Mailing Address - Street 1:3450 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3617
Mailing Address - Country:US
Mailing Address - Phone:203-374-6107
Mailing Address - Fax:203-374-6107
Practice Address - Street 1:3450 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3617
Practice Address - Country:US
Practice Address - Phone:203-374-6107
Practice Address - Fax:203-374-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment