Provider Demographics
NPI:1790410660
Name:COMMERCE HEARING AID OUTLET
Entity Type:Organization
Organization Name:COMMERCE HEARING AID OUTLET
Other - Org Name:COMMERCE HEARING AID OUTLET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-478-7440
Mailing Address - Street 1:800 STEVEN B TANGER BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-3554
Mailing Address - Country:US
Mailing Address - Phone:678-478-7440
Mailing Address - Fax:
Practice Address - Street 1:800 STEVEN B TANGER BLVD STE 307
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-3554
Practice Address - Country:US
Practice Address - Phone:678-478-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty