Healthcare Provider Details

I. General information

NPI: 1518383553
Provider Name (Legal Business Name): EAGLE HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E STATE ST STE 100
EAGLE ID
83616-5935
US

IV. Provider business mailing address

440 E STATE ST STE 100
EAGLE ID
83616-7499
US

V. Phone/Fax

Practice location:
  • Phone: 319-610-8111
  • Fax:
Mailing address:
  • Phone: 319-610-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-2414
License Number StateID

VIII. Authorized Official

Name: DR. ABRAM VORE
Title or Position: AUDIOLOGIST
Credential:
Phone: 319-610-8111