Healthcare Provider Details

I. General information

NPI: 1053487942
Provider Name (Legal Business Name): CENTER FOR SIGHT & HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 10/17/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8038 MACINTOSH LN
ROCKFORD IL
61107-5300
US

IV. Provider business mailing address

PO BOX 5944
ROCKFORD IL
61125-0944
US

V. Phone/Fax

Practice location:
  • Phone: 815-332-6800
  • Fax: 815-332-6810
Mailing address:
  • Phone: 815-332-6800
  • Fax: 815-332-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008174
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147000948
License Number StateIL

VIII. Authorized Official

Name: MAUREEN KOCH
Title or Position: PRESIDENT
Credential:
Phone: 815-332-6822