Provider Demographics
NPI:1386004539
Name:CRYSTAL CLEAR HEARING AIDS
Entity Type:Organization
Organization Name:CRYSTAL CLEAR HEARING AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGEUAY
Authorized Official - Suffix:
Authorized Official - Credentials:HEARINGAID DISPENSER
Authorized Official - Phone:714-630-7800
Mailing Address - Street 1:3855 E LA PALMA AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1700
Mailing Address - Country:US
Mailing Address - Phone:714-630-7800
Mailing Address - Fax:714-630-7803
Practice Address - Street 1:3855 E LA PALMA AVE STE 116
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1700
Practice Address - Country:US
Practice Address - Phone:714-630-7800
Practice Address - Fax:714-630-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8028237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356716708OtherNPI TYPE 1
CA1386004539OtherNPPES