Healthcare Provider Details

I. General information

NPI: 1841483906
Provider Name (Legal Business Name): R L VAUGH ENTERPRISES DBA MIRACLE EAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 S MARYLAND PKWY MIRACLE EAR HEARING INSIDE SEARS
LAS VEGAS NV
89109
US

IV. Provider business mailing address

PO BOX 70665
LAS VEGAS NV
89170
US

V. Phone/Fax

Practice location:
  • Phone: 702-650-9987
  • Fax: 702-965-9490
Mailing address:
  • Phone: 702-650-9987
  • Fax: 702-965-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberH03000581120586
License Number StateNV

VIII. Authorized Official

Name: MRS. LORRAINE VAUGHN
Title or Position: MGR OWNER
Credential:
Phone: 702-650-9987