Healthcare Provider Details

I. General information

NPI: 1720795396
Provider Name (Legal Business Name): JESSE LEE HUFFMAN HEARING AID DEALER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JESSE LEE HUFFMAN HEARING AID DEALER

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 E MORGAN AVE STE 104
EVANSVILLE IN
47711-4358
US

IV. Provider business mailing address

2205 E MORGAN AVE STE 104
EVANSVILLE IN
47711-4358
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-1226
  • Fax:
Mailing address:
  • Phone: 812-475-1226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001579A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: