Provider Demographics
NPI:1982735098
Name:WATERTOWN HEARING AID CENTER INC
Entity type:Organization
Organization Name:WATERTOWN HEARING AID CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-788-5249
Mailing Address - Street 1:20053 SUMMIT VIEW BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3619
Mailing Address - Country:US
Mailing Address - Phone:315-788-5249
Mailing Address - Fax:315-782-2464
Practice Address - Street 1:20053 SUMMIT VIEW BLVD
Practice Address - Street 2:STE 3
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3619
Practice Address - Country:US
Practice Address - Phone:315-788-5249
Practice Address - Fax:315-782-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004651-1156FX1800X
NY15000006650237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01509806Medicaid
NY1124320001Medicare NSC