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General NPI Number Information
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NPI Number | 1679719124
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Entity Type | Organization
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Legal Business Name | CLINT AND CAROLYN INC.
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 2250 W MODELLE AVE # D
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City | CLINTON
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State | OK
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Zip | 73601-3749
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Country | US
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Telephone | 580-323-9300
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Fax | 580-323-9300
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Provider Business Mailing Address
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Address Line | 2250 W MODELLE AVE # D
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City | CLINTON
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State | OK
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Zip | 73601-3749
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Country | US
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Telephone | 580-323-9300
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Fax | 580-323-9300
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID HIGGINBOTHAM
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Credential |
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Telephone | 580-323-9300
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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 | 963
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 943
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License Number State | OK
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