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General NPI Number Information
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NPI Number | 1972822690
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Entity Type | Organization
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Legal Business Name | MCRAY-DENTON HEARING AID CENTER
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 428 W GRAND AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-5865
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Country | US
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Telephone | 405-222-5555
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Fax | 405-222-2028
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Provider Business Mailing Address
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Address Line | 428 W GRAND AVE
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City | CHICKASHA
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State | OK
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Zip | 73018-5865
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Country | US
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Telephone | 405-222-5555
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Fax | 405-222-2028
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Authorized Official
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Title or Position | MGR./HEARING AID SPECIALIST
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Name | MR. MIKE L MANGUS
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Credential | ABOC, HIS
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Telephone | 405-222-5555
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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 | 679
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License Number State | OK
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