Provider Demographics
NPI:1558804096
Name:DON KUTIK
Entity Type:Organization
Organization Name:DON KUTIK
Other - Org Name:BEACH HEARING TECHNOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-301-0800
Mailing Address - Street 1:3525 BONITA BEACH RD
Mailing Address - Street 2:STE., 112
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4192
Mailing Address - Country:US
Mailing Address - Phone:239-301-0800
Mailing Address - Fax:239-301-0805
Practice Address - Street 1:3525 BONITA BEACH RD
Practice Address - Street 2:STE., 112
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4192
Practice Address - Country:US
Practice Address - Phone:239-301-0800
Practice Address - Fax:239-301-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS0002426237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty