Provider Demographics
NPI:1912215765
Name:FANTL HEARING, LLC
Entity Type:Organization
Organization Name:FANTL HEARING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:I
Authorized Official - Last Name:FANTL
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID SPECIALI
Authorized Official - Phone:216-896-0711
Mailing Address - Street 1:2642 EDGEWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-896-0710
Mailing Address - Fax:216-896-0711
Practice Address - Street 1:2642 EDGEWOOD RD.
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-896-0710
Practice Address - Fax:216-896-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02975237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty