Provider Demographics
NPI:1578897252
Name:FONNER HEARING AID CENTER
Entity Type:Organization
Organization Name:FONNER HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONNER
Authorized Official - Suffix:
Authorized Official - Credentials:BC, NBC-HIS, ACA,
Authorized Official - Phone:817-277-8121
Mailing Address - Street 1:315 E RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5838
Mailing Address - Country:US
Mailing Address - Phone:817-277-8121
Mailing Address - Fax:817-284-3253
Practice Address - Street 1:315 E RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5838
Practice Address - Country:US
Practice Address - Phone:817-277-8121
Practice Address - Fax:817-284-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50358332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50358OtherLICENSE NUMBER