Provider Demographics
NPI:1558490391
Name:WALL'S HEARING AID CENTER, INC.
Entity type:Organization
Organization Name:WALL'S HEARING AID CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-323-1612
Mailing Address - Street 1:4800 EASTON DR
Mailing Address - Street 2:SUITE #108
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-9427
Mailing Address - Country:US
Mailing Address - Phone:661-323-1612
Mailing Address - Fax:661-325-4969
Practice Address - Street 1:4800 EASTON DR
Practice Address - Street 2:SUITE #108
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-9427
Practice Address - Country:US
Practice Address - Phone:661-323-1612
Practice Address - Fax:661-325-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 2137237700000X
CAHA 805237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0008050Medicaid
CAHA0021370Medicaid