Basic Information
| Provider Information | |||||||||
| NPI: | 1972154342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 20/20 HEARING CARE NETWORK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 W CYPRESS CREEK RD STE 4 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333091715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549172337 | ||||||||
| FaxNumber: | 9549798988 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 W CYPRESS CREEK RD STE 4 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333091715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549172337 | ||||||||
| FaxNumber: | 9549798988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2019 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | COPPOLA | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9549172337 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.