MEDICARE: MATTHEW A JECKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	3143	OH

General Provider Information

NPI Number	:	1033450838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW A JECKER

Provider Business Mailing Address
First Line	:	1515 LANGDON DR
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-5006
Country	:	US
Telephone Number	:	937-572-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	6119 FAR HILLS AVE
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-1925
Country	:	US
Telephone Number	:	937-572-3333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	01/07/2019

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