Provider Demographics
NPI:1407046956
Name:EARMARK AUDIOLOGY
Entity Type:Organization
Organization Name:EARMARK AUDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:1440-255-1800
Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:200
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4597
Mailing Address - Country:US
Mailing Address - Phone:440-255-1800
Mailing Address - Fax:440-255-2088
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:200
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4597
Practice Address - Country:US
Practice Address - Phone:440-255-1800
Practice Address - Fax:440-255-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01292237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA-01292OtherUPIN
OH2531077Medicaid
OHOT4134472Medicare PIN