Provider Demographics
NPI:1518409127
Name:ACTIVEAR, LLC
Entity Type:Organization
Organization Name:ACTIVEAR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-506-3451
Mailing Address - Street 1:2935 N ASHLEY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1786
Mailing Address - Country:US
Mailing Address - Phone:229-245-1122
Mailing Address - Fax:229-245-1020
Practice Address - Street 1:2935 N ASHLEY ST STE 101
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1786
Practice Address - Country:US
Practice Address - Phone:229-245-1122
Practice Address - Fax:292-245-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADE034973332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment