Provider Demographics
NPI:1194841429
Name:WESSON, INC.
Entity Type:Organization
Organization Name:WESSON, INC.
Other - Org Name:WESSON HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:ACA
Authorized Official - Phone:209-823-2107
Mailing Address - Street 1:1079 EUCALYPTUS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4369
Mailing Address - Country:US
Mailing Address - Phone:209-823-2107
Mailing Address - Fax:209-823-0563
Practice Address - Street 1:1079 EUCALYPTUS ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4369
Practice Address - Country:US
Practice Address - Phone:209-823-2107
Practice Address - Fax:209-823-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1161332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0011610Medicaid