Provider Demographics
NPI:1497982201
Name:CRYSTAL CLEAR HEARING
Entity Type:Organization
Organization Name:CRYSTAL CLEAR HEARING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-216-1718
Mailing Address - Street 1:11342 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6567
Mailing Address - Country:US
Mailing Address - Phone:305-235-4035
Mailing Address - Fax:305-235-7298
Practice Address - Street 1:11342 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6567
Practice Address - Country:US
Practice Address - Phone:305-235-4035
Practice Address - Fax:305-235-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1884332S00000X
FLAS4846332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment