Provider Demographics
NPI:1194963587
Name:ALL EARS HEARING CENTER
Entity type:Organization
Organization Name:ALL EARS HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGMANS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD FAAA
Authorized Official - Phone:760-873-8848
Mailing Address - Street 1:621 W. LINE ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514
Mailing Address - Country:US
Mailing Address - Phone:760-873-8848
Mailing Address - Fax:760-873-9900
Practice Address - Street 1:621 W. LINE ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514
Practice Address - Country:US
Practice Address - Phone:760-873-8848
Practice Address - Fax:760-873-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2322231H00000X
CAAU2322231H00000X
CA7224332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX723Medicare UPIN