Provider Demographics
NPI:1689850513
Name:COMFORT WIGS ETC CO
Entity type:Organization
Organization Name:COMFORT WIGS ETC CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-488-8885
Mailing Address - Street 1:2410 S STEMMONS FWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8777
Mailing Address - Country:US
Mailing Address - Phone:214-488-8885
Mailing Address - Fax:972-316-8885
Practice Address - Street 1:2410 S STEMMONS FWY
Practice Address - Street 2:SUITE C
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8777
Practice Address - Country:US
Practice Address - Phone:214-488-8885
Practice Address - Fax:972-316-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000127387OtherSALON
TX0007336155OtherAETNA
TX530741OtherBLUE CROSS BLUE SHIELD TX
TX0007336155OtherAETNA