Provider Demographics
NPI:1891191813
Name:WATERFORD HEARING CENTER, LLC
Entity type:Organization
Organization Name:WATERFORD HEARING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-599-7448
Mailing Address - Street 1:3086 CAIRNCROSS DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-2702
Mailing Address - Country:US
Mailing Address - Phone:248-599-7448
Mailing Address - Fax:
Practice Address - Street 1:5907 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3361
Practice Address - Country:US
Practice Address - Phone:248-599-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment