Provider Demographics
NPI:1679138317
Name:SPRY CLEAR EAR,
Entity type:Organization
Organization Name:SPRY CLEAR EAR,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPRY
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID DEALER/
Authorized Official - Phone:219-934-9747
Mailing Address - Street 1:827 W 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2027
Mailing Address - Country:US
Mailing Address - Phone:219-934-9747
Mailing Address - Fax:219-922-9745
Practice Address - Street 1:827 W 45TH AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2027
Practice Address - Country:US
Practice Address - Phone:219-934-9747
Practice Address - Fax:219-922-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100385260AMedicaid