Provider Demographics
NPI:1376305086
Name:WALNUT CREEK AUDIOLOGY CORP
Entity Type:Organization
Organization Name:WALNUT CREEK AUDIOLOGY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/ OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:707-494-4328
Mailing Address - Street 1:1900 OLYMPIC BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5094
Mailing Address - Country:US
Mailing Address - Phone:925-937-4455
Mailing Address - Fax:
Practice Address - Street 1:1900 OLYMPIC BLVD STE 202
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5094
Practice Address - Country:US
Practice Address - Phone:925-937-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty