Healthcare Provider Details

I. General information

NPI: 1174003735
Provider Name (Legal Business Name): STEVEN DAVIS FITTING AND DISPENSI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W 7TH AVE
CORSICANA TX
75110-6316
US

IV. Provider business mailing address

7221 W 79TH ST STE 205
OVERLAND PARK KS
66204-2978
US

V. Phone/Fax

Practice location:
  • Phone: 903-875-0534
  • Fax: 903-875-0515
Mailing address:
  • Phone: 913-951-3590
  • Fax: 913-701-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number80816
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: