Provider Demographics
NPI:1548002322
Name:FARGHER LAKE HEARING AIDS LLC
Entity type:Organization
Organization Name:FARGHER LAKE HEARING AIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-263-4000
Mailing Address - Street 1:26916 NE 434TH ST
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:WA
Mailing Address - Zip Code:98601-4636
Mailing Address - Country:US
Mailing Address - Phone:360-263-4000
Mailing Address - Fax:360-369-0000
Practice Address - Street 1:15518 NE FARGHER LAKE HWY
Practice Address - Street 2:
Practice Address - City:YACOLT
Practice Address - State:WA
Practice Address - Zip Code:98675-4508
Practice Address - Country:US
Practice Address - Phone:360-263-4000
Practice Address - Fax:360-369-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty