Healthcare Provider Details

I. General information

NPI: 1487908844
Provider Name (Legal Business Name): JON M RICHARDSON HEARING SPECIALIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ELKIN HWY SUITE #E
NORTH WILKESBORO NC
28659-3468
US

IV. Provider business mailing address

302 4TH ST SW
HICKORY NC
28602-2819
US

V. Phone/Fax

Practice location:
  • Phone: 336-838-8886
  • Fax: 336-838-8886
Mailing address:
  • Phone: 828-322-9323
  • Fax: 828-322-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number698A01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: