Provider Demographics
NPI:1124142534
Name:WIMMER, GREG L (HEARING AID SALES)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:L
Last Name:WIMMER
Suffix:
Gender:M
Credentials:HEARING AID SALES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6115
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-6115
Mailing Address - Country:US
Mailing Address - Phone:304-324-8358
Mailing Address - Fax:304-324-8308
Practice Address - Street 1:4 GREEN VALLEY PLAZA
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701
Practice Address - Country:US
Practice Address - Phone:304-324-8358
Practice Address - Fax:304-324-8308
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV789237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist