Provider Demographics
NPI:1417102328
Name:KOVAL, ERIC THOMAS (RN, BSN, HCP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:THOMAS
Last Name:KOVAL
Suffix:
Gender:M
Credentials:RN, BSN, HCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 E FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6380
Mailing Address - Country:US
Mailing Address - Phone:719-520-9099
Mailing Address - Fax:
Practice Address - Street 1:941 E FILLMORE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6380
Practice Address - Country:US
Practice Address - Phone:719-520-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80249237700000X
CO204237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO204OtherDORA