Provider Demographics
NPI:1104124387
Name:REALEAR, INC
Entity type:Organization
Organization Name:REALEAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HAS-ACA
Authorized Official - Phone:386-447-3530
Mailing Address - Street 1:1000 PALM COAST PKWY SW
Mailing Address - Street 2:SUITE #109
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4746
Mailing Address - Country:US
Mailing Address - Phone:386-447-3530
Mailing Address - Fax:386-447-3633
Practice Address - Street 1:1000 PALM COAST PKWY SW
Practice Address - Street 2:SUITE #109
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4746
Practice Address - Country:US
Practice Address - Phone:386-447-3530
Practice Address - Fax:386-447-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty