Provider Demographics
NPI:1306186952
Name:EDISON STANFORD HEARING AID CENTER
Entity Type:Organization
Organization Name:EDISON STANFORD HEARING AID CENTER
Other - Org Name:EDISON STANFORD ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:HEARING AID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:BCHIS
Authorized Official - Phone:801-373-5887
Mailing Address - Street 1:777 N 500 W
Mailing Address - Street 2:SUITE 005
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1541
Mailing Address - Country:US
Mailing Address - Phone:801-373-5887
Mailing Address - Fax:801-375-2293
Practice Address - Street 1:777 N 500 W
Practice Address - Street 2:SUITE 005
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1541
Practice Address - Country:US
Practice Address - Phone:801-373-5887
Practice Address - Fax:801-375-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT76827944601332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment