Provider Demographics
NPI:1245651520
Name:CRYSTAL CLEAR HEARING AND AUDIOLOGY, LLC
Entity type:Organization
Organization Name:CRYSTAL CLEAR HEARING AND AUDIOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER / MANAGER
Authorized Official - Phone:276-200-8463
Mailing Address - Street 1:22477 WYLDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211
Mailing Address - Country:US
Mailing Address - Phone:276-200-8463
Mailing Address - Fax:423-536-9923
Practice Address - Street 1:60 25TH ST. NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-508-9553
Practice Address - Fax:423-536-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment