Healthcare Provider Details

I. General information

NPI: 1659650448
Provider Name (Legal Business Name): MARY DUVAL HEARING AID CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E. 37TH STREET
DAVENPORT IA
52807-1901
US

IV. Provider business mailing address

1220 E. 37TH STREET
DAVENPORT IA
52807-1901
US

V. Phone/Fax

Practice location:
  • Phone: 563-386-2986
  • Fax: 563-386-2991
Mailing address:
  • Phone: 563-386-2986
  • Fax: 563-386-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number466
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number466
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number466
License Number StateIA

VIII. Authorized Official

Name: MRS. MARY HELEN DUVAL
Title or Position: OWNER
Credential: IA LICENSE #466
Phone: 563-386-2986