Provider Demographics
NPI:1164731238
Name:FOREN, EDDIE W (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:W
Last Name:FOREN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 S EASTERN AVE
Mailing Address - Street 2:SUITE #228
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-8024
Mailing Address - Country:US
Mailing Address - Phone:702-260-4655
Mailing Address - Fax:702-260-4665
Practice Address - Street 1:9480 S EASTERN AVE
Practice Address - Street 2:SUITE #228
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8024
Practice Address - Country:US
Practice Address - Phone:702-260-4655
Practice Address - Fax:702-260-4665
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV153237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist