Basic Information
| Provider Information | |||||||||
| NPI: | 1336775485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORTON | ||||||||
| FirstName: | LANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | MIRACLE EAR | ||||||||
| Address2: | 1206 SILAS DEANE HWY | ||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607573636 | ||||||||
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| Practice Location | |||||||||
| Address1: | MIRACLE EAR | ||||||||
| Address2: | 1206 SILAS DEANE HWY | ||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607573636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2020 | ||||||||
| LastUpdateDate: | 03/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 448 | CT | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.