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General NPI Number Information
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NPI Number | 1669613212
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Entity Type | Organization
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Legal Business Name | HAESLY RETAIL SERVICES, INC.
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 4111 FAIRMONT PKWY
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City | PASADENA
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State | TX
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Zip | 77504-3339
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Country | US
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Telephone | 713-472-0000
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Fax | 281-487-0244
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Provider Business Mailing Address
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Address Line | 4111 FAIRMONT PKWY
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City | PASADENA
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State | TX
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Zip | 77504-3339
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Country | US
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Telephone | 713-472-0000
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Fax | 281-487-0244
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Authorized Official
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Title or Position | OWNER
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Name | MR. KENNETH BANKS HAESLY
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Credential |
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Telephone | 713-472-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 50027
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License Number State | TX
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