Provider Demographics
NPI:1437578143
Name:DVC HEARING SERVICES INC
Entity Type:Organization
Organization Name:DVC HEARING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:DERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-997-8585
Mailing Address - Street 1:8771 PERIMETER PARK COURT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2278
Mailing Address - Country:US
Mailing Address - Phone:904-997-8585
Mailing Address - Fax:904-998-0054
Practice Address - Street 1:8771 PERIMETER PARK COURT
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2278
Practice Address - Country:US
Practice Address - Phone:904-997-8585
Practice Address - Fax:904-998-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1834237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1327Medicare UPIN