Provider Demographics
NPI:1356612345
Name:BOB EVANS HEARING CENTER,INC.
Entity type:Organization
Organization Name:BOB EVANS HEARING CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:BS;BC-HIS
Authorized Official - Phone:727-393-3775
Mailing Address - Street 1:9156 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3148
Mailing Address - Country:US
Mailing Address - Phone:727-393-3775
Mailing Address - Fax:
Practice Address - Street 1:9156 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3148
Practice Address - Country:US
Practice Address - Phone:727-393-3775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1373332S00000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty