Provider Demographics
NPI:1164671806
Name:CITYVIEW AUDIOLOGY & HEARING AIDS, INC.
Entity Type:Organization
Organization Name:CITYVIEW AUDIOLOGY & HEARING AIDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED IN AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BLAISING
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, FAAA, CCC-A
Authorized Official - Phone:817-821-1505
Mailing Address - Street 1:7801 OAKMONT BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4242
Mailing Address - Country:US
Mailing Address - Phone:817-263-1800
Mailing Address - Fax:817-821-1505
Practice Address - Street 1:7801 OAKMONT BLVD STE 109
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4242
Practice Address - Country:US
Practice Address - Phone:817-263-1800
Practice Address - Fax:817-821-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51489237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48150Medicare UPIN