Provider Demographics
NPI:1407865025
Name:HAESLY RETAIL SERVICES, INC.
Entity Type:Organization
Organization Name:HAESLY RETAIL SERVICES, INC.
Other - Org Name:WALKER HEARING AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BANKS
Authorized Official - Last Name:HAESLY
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:713-869-4700
Mailing Address - Street 1:1708 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1410
Mailing Address - Country:US
Mailing Address - Phone:713-869-4700
Mailing Address - Fax:713-869-3578
Practice Address - Street 1:1708 W 24TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1410
Practice Address - Country:US
Practice Address - Phone:713-869-4700
Practice Address - Fax:713-869-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty