Organization
CDPA, INC
Active
Other names
Lake Regional Hearing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRICK T AYNES HIS (OWNER/HEARING INSTRUMENT SPECIALIST)
(352) 360-0554
Entity
Organization
Contact information
Practice address
8112 CENTRALIA CT, SUITE 104, LEESBURG, FL 34788-3700
(352) 360-0554
(352) 360-1788
Mailing address
8112 CENTRALIA CT, SUITE 104, LEESBURG, FL 34788-3700
(352) 360-0554
(352) 360-1788
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
AS4310
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J001M
BCBS
FL
01
—
J001R
BCBS
FL
Enumeration date
03/03/2010
Last updated
03/09/2010
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