Provider Demographics
NPI:1558585349
Name:VALA VL BUJAK HEARING AID SERVICE
Entity Type:Organization
Organization Name:VALA VL BUJAK HEARING AID SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALA
Authorized Official - Middle Name:VL
Authorized Official - Last Name:BUJAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:574-583-6601
Mailing Address - Street 1:801 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1757
Mailing Address - Country:US
Mailing Address - Phone:574-583-6601
Mailing Address - Fax:574-583-6601
Practice Address - Street 1:801 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1757
Practice Address - Country:US
Practice Address - Phone:574-583-6601
Practice Address - Fax:574-583-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002220A231H00000X
IN17000695237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN807000Medicare ID - Type UnspecifiedDISPENSING