Provider Demographics
NPI:1629423215
Name:GOMER HEARING, LLC
Entity Type:Organization
Organization Name:GOMER HEARING, LLC
Other - Org Name:GOMER HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:972-803-8072
Mailing Address - Street 1:4011 E RENNER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2917
Mailing Address - Country:US
Mailing Address - Phone:972-803-8072
Mailing Address - Fax:214-238-3806
Practice Address - Street 1:4011 E RENNER RD STE 108
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2917
Practice Address - Country:US
Practice Address - Phone:972-803-8072
Practice Address - Fax:214-238-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51350231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
342114ZSLSOtherMEDICARE PTAN
1427314772OtherNPI