Healthcare Provider Details

I. General information

NPI: 1437361342
Provider Name (Legal Business Name): IMAGINEARS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 HIGHWAY 99 N SUITE 8
ASHLAND OR
97520-9120
US

IV. Provider business mailing address

1875 HIGHWAY 99 N SUITE 8
ASHLAND OR
97520-9120
US

V. Phone/Fax

Practice location:
  • Phone: 541-488-0628
  • Fax: 541-552-0628
Mailing address:
  • Phone: 541-488-0628
  • Fax: 541-552-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number22174
License Number StateOR

VIII. Authorized Official

Name: MRS. KRISTEN A BECK
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-776-3461