Provider Demographics
NPI:1356188718
Name:COMMERCE HEARING AID OUTLET
Entity type:Organization
Organization Name:COMMERCE HEARING AID OUTLET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-478-7440
Mailing Address - Street 1:125 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2105
Mailing Address - Country:US
Mailing Address - Phone:678-478-7440
Mailing Address - Fax:
Practice Address - Street 1:125 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2105
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:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty