Healthcare Provider Details

I. General information

NPI: 1790068864
Provider Name (Legal Business Name): EDMOND HEARING DOCTORS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2011
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E DANFORTH RD SUITE 118
EDMOND OK
73034-4483
US

IV. Provider business mailing address

307 E DANFORTH RD SUITE 118
EDMOND OK
73034-4483
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-1800
  • Fax:
Mailing address:
  • Phone: 405-341-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number351
License Number StateOK

VIII. Authorized Official

Name: DR. TREVOR COUROULEAU
Title or Position: AUDIOLOGIST/OWNER
Credential: AU.D.
Phone: 405-341-1800