Provider Demographics
NPI:1386967438
Name:CDPA, INC
Entity type:Organization
Organization Name:CDPA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEARING INSTRUMENT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:AYNES
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:352-360-0554
Mailing Address - Street 1:8112 CENTRALIA CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3700
Mailing Address - Country:US
Mailing Address - Phone:352-360-0554
Mailing Address - Fax:352-360-1788
Practice Address - Street 1:8112 CENTRALIA CT
Practice Address - Street 2:SUITE 104
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3700
Practice Address - Country:US
Practice Address - Phone:352-360-0554
Practice Address - Fax:352-360-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4310332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ001MOtherBCBS
FLJ001ROtherBCBS