Provider Demographics
NPI:1386913689
Name:ORANGE PARK AUDIOLOGY CLINIC
Entity type:Organization
Organization Name:ORANGE PARK AUDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-278-9828
Mailing Address - Street 1:1542 KINGSLEY AVE
Mailing Address - Street 2:SUITE 141
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4586
Mailing Address - Country:US
Mailing Address - Phone:904-278-9828
Mailing Address - Fax:904-278-9818
Practice Address - Street 1:1542 KINGSLEY AVE
Practice Address - Street 2:SUITE 141
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4586
Practice Address - Country:US
Practice Address - Phone:904-278-9828
Practice Address - Fax:904-278-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLAY1067332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003911700Medicaid
FL003911700Medicaid