Healthcare Provider Details

I. General information

NPI: 1891972394
Provider Name (Legal Business Name): EARS OF ARDMORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 N COMMERCE ST STE 111
ARDMORE OK
73401-1859
US

IV. Provider business mailing address

1505 N COMMERCE ST STE 111
ARDMORE OK
73401-1859
US

V. Phone/Fax

Practice location:
  • Phone: 580-224-0377
  • Fax: 580-226-2237
Mailing address:
  • Phone: 580-224-0377
  • Fax: 580-226-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number316
License Number StateOK

VIII. Authorized Official

Name: DR. JENI A MERRICK
Title or Position: OWNER
Credential: AU., D
Phone: 580-224-0377