Provider Demographics
NPI:1720472814
Name:CLEAR EAR HEARING OF NORTHEAST FLORIDA, LLC.
Entity Type:Organization
Organization Name:CLEAR EAR HEARING OF NORTHEAST FLORIDA, LLC.
Other - Org Name:CLEAR EAR HEARING SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:HAS-NBC
Authorized Official - Phone:904-579-4814
Mailing Address - Street 1:1871 WELLS RD STE 10
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1871 WELLS RD STE 10
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2350
Practice Address - Country:US
Practice Address - Phone:904-579-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 2210332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment