Bryan Wall, BC-HIS

Primary specialty

Hearing Instrument SpecialistTaxonomy code 237700000X

License

HA 00004733 Issued in WA

Practice address

15518 NE Fargher Lake Hwy
Yacolt, WA 98675-4508

Phone

(360) 263-4000

NPI assigned

Oct 21, 2010

Last updated

Oct 21, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fargher Lake Hearing AIDS LLC

  • Hearing Instrument Specialist
  • Yacolt, WA
  • NPI 1548002322
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287619200000",
    "number": "1578863700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26916 NE 434TH ST",
            "city": "AMBOY",
            "state": "WA",
            "postal_code": "986014636",
            "telephone_number": "360-247-6590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15518 NE FARGHER LAKE HWY",
            "city": "YACOLT",
            "state": "WA",
            "postal_code": "986754508",
            "telephone_number": "360-263-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "BRYAN",
        "credential": "BC-HIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "WA",
            "license": "HA 00004733",
            "primary": true
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "OR",
            "license": "HAS-P-509154",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SATET OF WASHINGTON  L&I PROVIDER",
            "identifier": "LNI 254658",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Robertson, PARAMEDIC
• Delora Rosenlund, LMT
• Laurel Sanders, DOULA
• Carla Pasagui Ines Syron, OTR/L
• Jeanne Vollmer-Cox
• Arielle Zieja, LMHCA, APCC

• Hearing Instrument Specialist in Yacolt, WA
• Providers in Yacolt, WA by specialty
• Hearing Instrument Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.