Provider Demographics
NPI:1689076572
Name:ILLUMINEAR TINNITUS & AUDIOLOGY CENTER
Entity Type:Organization
Organization Name:ILLUMINEAR TINNITUS & AUDIOLOGY CENTER
Other - Org Name:ILLUMINEAR AUDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:512-407-9215
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:SUITE B14
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-407-9215
Mailing Address - Fax:
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:SUITE B14
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-407-9215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51189231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty