Healthcare Provider Details

I. General information

NPI: 1710936836
Provider Name (Legal Business Name): LIVINGSTON HEARING AID CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 50TH STREET
LUBBOCK TX
79414
US

IV. Provider business mailing address

5303 50TH STREET
LUBBOCK TX
79414
US

V. Phone/Fax

Practice location:
  • Phone: 806-799-8950
  • Fax: 806-792-9404
Mailing address:
  • Phone: 806-799-8950
  • Fax: 806-792-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number50044
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RICHARD R DAVILA II
Title or Position: PRESIDENT
Credential:
Phone: 806-799-8950