Basic Information
| Provider Information | |||||||||
| NPI: | 1497170476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONDER | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | HAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1076 E VENICE AVE | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342857162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412570530 | ||||||||
| FaxNumber: | 9413750142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1076 E VENICE AVE | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342857162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412570530 | ||||||||
| FaxNumber: | 9413750142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS4889 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.