Provider Demographics
NPI:1770062978
Name:LIFE HEARING & AUDIOLOGY CLINICS LLC
Entity type:Organization
Organization Name:LIFE HEARING & AUDIOLOGY CLINICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLEINDL
Authorized Official - Suffix:III
Authorized Official - Credentials:HAS, BC-HHS, ACA
Authorized Official - Phone:239-649-5433
Mailing Address - Street 1:720 N GOODLETTE RD #200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-649-5433
Mailing Address - Fax:
Practice Address - Street 1:923 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-984-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE HEARING & AUDIOLOGY CLINICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4986237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty