Healthcare Provider Details

I. General information

NPI: 1558704015
Provider Name (Legal Business Name): KUYKENDALL HEARING AID CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 N VAN BUREN ST STE 200
ENID OK
73703-1800
US

IV. Provider business mailing address

3201 N VAN BUREN ST STE 200
ENID OK
73703-1800
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-6168
  • Fax:
Mailing address:
  • Phone: 580-234-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number855
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number219
License Number StateOK

VIII. Authorized Official

Name: R GREG KUYKENDALL
Title or Position: MANAGER
Credential:
Phone: 580-234-6168