Provider Demographics
NPI:1386188092
Name:VISTA HEARING TECHNOLOGY
Entity Type:Organization
Organization Name:VISTA HEARING TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONIFACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-264-8344
Mailing Address - Street 1:290 E MILLTOWN RD
Mailing Address - Street 2:STE B
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-6113
Mailing Address - Country:US
Mailing Address - Phone:330-264-8344
Mailing Address - Fax:330-264-8366
Practice Address - Street 1:290 E MILLTOWN RD
Practice Address - Street 2:STE B
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-6113
Practice Address - Country:US
Practice Address - Phone:330-264-8344
Practice Address - Fax:330-264-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03297332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment