Provider Demographics
NPI:1457674624
Name:VISTA HEARING AID AND REPAIR CENTER
Entity Type:Organization
Organization Name:VISTA HEARING AID AND REPAIR CENTER
Other - Org Name:VISTA HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:NBC-HIS
Authorized Official - Phone:717-504-8459
Mailing Address - Street 1:183 S COLDBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2759
Mailing Address - Country:US
Mailing Address - Phone:717-504-8459
Mailing Address - Fax:717-504-8596
Practice Address - Street 1:183 S COLDBROOK AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2759
Practice Address - Country:US
Practice Address - Phone:717-504-8459
Practice Address - Fax:717-504-8596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03115237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1580980OtherMEDICARE ASSURED