Provider Demographics
NPI:1609017888
Name:MIRACLE EAR
Entity Type:Organization
Organization Name:MIRACLE EAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-736-2284
Mailing Address - Street 1:660 W WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 W WINTON AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2135
Practice Address - Country:US
Practice Address - Phone:510-784-0233
Practice Address - Fax:510-259-1774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST COAST HEARING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2693332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment