Provider Demographics
NPI:1326869298
Name:GOLD STAR AUDIOLOGY CLINIC
Entity type:Organization
Organization Name:GOLD STAR AUDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:360-892-3445
Mailing Address - Street 1:16209 SE MCGILLIVRAY BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9034
Mailing Address - Country:US
Mailing Address - Phone:360-892-3445
Mailing Address - Fax:360-213-2044
Practice Address - Street 1:209 MASON RUNN LN
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-1699
Practice Address - Country:US
Practice Address - Phone:360-892-3445
Practice Address - Fax:360-213-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid Equipment