Provider Demographics
NPI:1578079398
Name:HEARING RETAIL PARTNERS II LLC
Entity Type:Organization
Organization Name:HEARING RETAIL PARTNERS II LLC
Other - Org Name:OPTIUM HEARING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:DANNETTE
Authorized Official - Last Name:WAITE-MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-854-6774
Mailing Address - Street 1:4838 E BASELINE RD STE 128A
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4673
Mailing Address - Country:US
Mailing Address - Phone:480-854-6774
Mailing Address - Fax:
Practice Address - Street 1:339 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3513
Practice Address - Country:US
Practice Address - Phone:480-854-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARING RETAIL PARTNERS II LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHAD10525237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty