Provider Demographics
NPI:1043595333
Name:DAVIS, RICHARD JOE (HEARING AID DEALER)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:HEARING AID DEALER
Other - Prefix:MR
Other - First Name:RICK
Other - Middle Name:JOE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HEARING AID DEALER
Mailing Address - Street 1:703 E ALAMEDA RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3659
Mailing Address - Country:US
Mailing Address - Phone:208-234-1330
Mailing Address - Fax:208-233-4234
Practice Address - Street 1:703 E ALAMEDA RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3659
Practice Address - Country:US
Practice Address - Phone:208-234-1330
Practice Address - Fax:208-233-4234
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA11237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist