Provider Demographics
NPI:1326160375
Name:BENCAL
Entity Type:Organization
Organization Name:BENCAL
Other - Org Name:MIRACLE-EAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NEIHEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID DISPENSE
Authorized Official - Phone:559-244-6060
Mailing Address - Street 1:7391 N PALM AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5512
Mailing Address - Country:US
Mailing Address - Phone:559-244-6060
Mailing Address - Fax:559-244-6066
Practice Address - Street 1:7391 N PALM AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5512
Practice Address - Country:US
Practice Address - Phone:559-244-6060
Practice Address - Fax:559-244-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA6075237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ67409ZOtherBLUE SHIELD
CAHA0039581Medicaid