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General NPI Number Information
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NPI Number | 1952702656
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Entity Type | Organization
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Legal Business Name | HEARING LAB TECHNOLOGY
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 12905 E 96TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-4719
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Country | US
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Telephone | 405-308-4973
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Fax |
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Provider Business Mailing Address
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Address Line | 12905 E 96TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-4719
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Country | US
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Telephone | 405-308-4973
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Fax |
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Authorized Official
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Title or Position | HEARING INSTRUMENT SPECIALIST
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Name | GERARD RUTHERFORD
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Credential |
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Telephone | 918-914-1669
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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 | 1039
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License Number State | OK
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