Provider Demographics
NPI:1912377318
Name:AUDIO HEARING AID CENTER
Entity Type:Organization
Organization Name:AUDIO HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-889-6513
Mailing Address - Street 1:1997 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1944
Mailing Address - Country:US
Mailing Address - Phone:541-889-6513
Mailing Address - Fax:
Practice Address - Street 1:1997 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1944
Practice Address - Country:US
Practice Address - Phone:541-889-6513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-276799235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Single Specialty