Provider Demographics
NPI:1912404989
Name:OMNI ADVANCED HEARING AID CENTER
Entity Type:Organization
Organization Name:OMNI ADVANCED HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MCCONNELLHIS
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:330-491-9810
Mailing Address - Street 1:4156 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2820
Mailing Address - Country:US
Mailing Address - Phone:330-491-9810
Mailing Address - Fax:339-491-9810
Practice Address - Street 1:4156 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2820
Practice Address - Country:US
Practice Address - Phone:330-491-9810
Practice Address - Fax:339-491-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1784261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech