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General NPI Number Information
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NPI Number | 1700908415
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Entity Type | Organization
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Legal Business Name | MIRACLE EAR HEARING AID CENTER
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 605 S MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-3041
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Country | US
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Telephone | 573-471-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 605 S MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-3041
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Country | US
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Telephone | 573-471-0187
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT PETERS
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Credential |
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Telephone | 573-471-0187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA001246
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License Number State | MO
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