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General NPI Number Information
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NPI Number | 1053487942
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Entity Type | Organization
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Legal Business Name | CENTER FOR SIGHT & HEARING
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 8038 MACINTOSH LN
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City | ROCKFORD
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State | IL
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Zip | 61107-5300
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Country | US
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Telephone | 815-332-6800
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Fax | 815-332-6810
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Provider Business Mailing Address
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Address Line | PO BOX 5944
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City | ROCKFORD
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State | IL
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Zip | 61125-0944
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Country | US
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Telephone | 815-332-6800
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Fax | 815-332-6810
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAUREEN KOCH
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Credential |
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Telephone | 815-332-6822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046008174
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147000948
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License Number State | IL
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