Provider Demographics
NPI:1346447505
Name:FONNER HEARING AID CENTER
Entity Type:Organization
Organization Name:FONNER HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:FONNER
Authorized Official - Suffix:
Authorized Official - Credentials:BC, NBC-HIS, ACA
Authorized Official - Phone:817-284-8584
Mailing Address - Street 1:6647 BOULEVARD 26
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1570
Mailing Address - Country:US
Mailing Address - Phone:817-284-8584
Mailing Address - Fax:817-284-3253
Practice Address - Street 1:6647 BOULEVARD 26
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76180-1570
Practice Address - Country:US
Practice Address - Phone:817-284-8584
Practice Address - Fax:817-284-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50312261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech